Anesthesia Coding Alert

Include every detail of the service in your claim.

Many anesthesiologists administer MAC (monitored anesthesia care) rather than general anesthesia during these GI procedures. When that’s the case, remember to append the appropriate MAC modifiers as needed:

• QS (Monitored anesthesia care service) for Medicare patients, unless a G8 or G9 modifier is required
• 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) when the patient’s medical history warrants it and you have supporting documentation

There might also be times when you’re justified in reporting a qualifying circumstances (or QC) code in addition to the anesthesia code, as long as it is not already included in the base value (such as 00326). These codes can help support the need for anesthesia.

For example, performing the procedure on a patient of extreme age could allow you to include the “qualifying circumstances” code +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)). Remember, however, you won’t earn additional Medicare payment for QC codes. Include them on the claim to paint a clearer picture of the situation but know that they won’t add to your bottom line.