Anesthesia Coding Alert

It's not uncommon for commercial carriers to follow Medicare's lead on whether to reimburse for certain procedure codes, but Aetna is taking that mind-set a step further. Beginning this summer, Aetna began requiring that claims submitted to them include the Medicare modifiers for MAC (monitored anesthesia care) and medically directed CRNAs as appropriate. The modifiers affected by the new policy include:
  -AD Medical supervision by a physician: more than four concurrent anesthesia procedures

-G8 Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure

-G9 Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition

-QK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals -QX CRNA service: with medical direction by a physician

-QY Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist Other commercial carriers may soon follow suit; at press time, sources reported that United Healthcare was in the process of instituting the same guidelines, but nothing had been officially announced.

"If this works for Aetna, then I think you'll see carriers all over the U.S. trying the same thing," says Anesthesia & Pain Management Coding Alert's consulting editor Barbara Johnson, CPC, MPC. Whether other carriers follow Aetna's lead or not, this policy obviously affects all anesthesia billers and coders. Stay tuned for more information on the changes in next month's issue of Anesthesia & Pain Management Coding Alert.