# MAC for Colonscopies



## Lisa Bledsoe (Apr 23, 2009)

Does anyone do this?


----------



## code3jill (Apr 23, 2009)

i code for colon/medicare all the time,what is the question?


----------



## Anna Weaver (Apr 23, 2009)

*mac*

Most of ours are not MAC, I think the majority here are conscious sedation, and the few we do get with anesthesia do not use MAC, they just do general. Sorry, I can't help you much.


----------



## ohiocoder101 (Apr 23, 2009)

I use MAC all of the time for our CRNAs. whats your question?


----------



## Lisa Bledsoe (Apr 23, 2009)

Specifically, does anyone do colonoscopies under MAC?  If so, is it reimbursed?


----------



## jdrueppel (Apr 23, 2009)

Yes, we do and yes, they are covered.  We currently have NO issues with reimbursement from any carrier - I'm sure I'll be struck by lightening for saying that.  In the past we've had payment issues from Medicare, however, our current carrier (WPS) has no monitored anesthesia care policy.

Julie, CPC


----------



## Lisa Bledsoe (Apr 23, 2009)

*medical necessity*

Julie - do you have an ABN or waiver signed for medical necessity?


----------



## jdrueppel (Apr 23, 2009)

No ABN or waivers are not routinely done.  There are occasions when we do get a Medicare ABN signed as a result of our previous Medicare carrier having a rigid MAC LCD and the anesthesia providers just following previous guidelines.  I have spoken to my administrator about this as it is only appropriate to have the beneficiary sign an ABN when the provider knows the service is noncovered which, per my previous post, there is no current local coverage determination with our current Medicare carrier -- but I won't go into this situation.  We have never had Medicaid or Commercial insured patient's sign waivers.  Of recent, I can only think of one colonscopy that has been denied and it was a Medicaid denial of screening colonoscopy (GI surgeon was also denied payment) and pt had no symptoms which is not covered by Nebraska Medicaid.

Julie, CPC


----------



## Lisa Bledsoe (Apr 23, 2009)

Julie - I appreciate your input.  I find it interesting that some places outside of the US are doing colonoscopies without even conscious sedation, yet we in the US are even going so far as to use MAC or general anesthesia.  I do not do anesthesia coding but I work for a multi-specialty group and we also have an ASC.  The Anesthesia group that provides services in our facility approached our GI docs with this idea.  One wants to do it, one does not.  I'm just trying to gather my facts for them and our ASC manager.  Thanks again.

If anyone else has anything to add I'd love to hear from you!


----------



## jdrueppel (Apr 23, 2009)

Lisa,

The colonoscopies and EGDs that we provide anesthesia for are in a hospital inpatient and outpatient setting.  For the most part our GI patient's are Medicare beneficiaries with co-mobidities (i.e. renal failure, heart failure, DM) or mentally challenged.  We do not currently provide anesthesia for these services at any ASC or GI specific facility but there is a free standing GI facility in town that does offer in office endoscopy services.  Because we are not affiliated with the facility I'm not certain if it is an ASC or not.  These are the same surgeons that bring the Medicare patients to my hospital for endoscopy under anesthesia.

I see by your profile that you are from Colorado.  I'm also finding that your Medicare Part B contractor is TrailBlazers.  This carrier DOES have a Monitored Anesthesia Care (MAC) LCD.  Per this LCD both of the endoscopy anesthesia codes 00740 and 00810 are among the list of codes that require medical necessity by way of either a specific diagnosis from the covered diagnosis list OR -G9 modifier.  I have attached the Trailblazer link to the policy.

http://www.trailblazerhealth.com/Tools/Local Coverage Determinations/Default.aspx?id=2831&DomainID=1

Feel free to send me a private message with your phone number if you want to discuss any of this in detail.

Julie, CPC


----------

