# MAC vs. General



## Melissa*Ever*Evolving (Nov 9, 2012)

Hello, 
I have an anesthesiologist telling me if propofol is used in a procedure, it is automatically reportable as general opposed to MAC. He is performing a lot of colonoscopy cases. Is this true?!? I have been coding for anesthesia for almost 5 years and I have seen propofol used in MAC procedures. Please guide me in a direction to materials on this to let my dr. know. I thought only if they have loss of consciousness then it is considered general.

Thank you for your time!

~Melissa


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## cbaldia (Nov 9, 2012)

Melissa,
Refer to the 2012 Relative Value guide that is published by the American Society of Anesthesiologists.(the little blue book)   In the section entitled  "Position on Monitored Anesthesia Care" (pg 45)  it states, " If the patient loses consciousness and the ability to respond purposefully, the anesthesia care is a general anesthetic, irrespective of whether airway insturmentation is required."   So the determining factor of MAC vs. general is NOT the drugs, or the protected airway- it is the loss of consciousness. As your Dr. in in the procedure room, he is aware if the patient is losing consciousness or not.  If he states it is general and indicates such on the record, regardless of the drugs or amounts, then it should be a general. 

I would also review your top carrier policies on MAC, especially medicare's LCD for MAC on colonoscopies.  If he is doing MAC for colonoscopies and does not have the supporting medical necessity i.e. co-morbid diagnoses, he won't get paid, but will for general.   

Hope this helps.


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## Melissa*Ever*Evolving (Nov 13, 2012)

Thank you for your helpful response. I thought this was the case, I just needed reaffirmed before I try re-educating my doctor. I couldn't think of a resource to fall back on.

Thanks again!

~Melissa


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