Anesthesia Coding Alert

HCPCS 2001 states that modifiers should, or in some cases must, be used to identify circumstances that alter or enhance the description of a service or supply. Yet, local medical review policies (LMRPs) and private-carrier requirements on the use of modifiers on anesthesia claims vary from state to state. For anesthesia coders, one of the biggest challenges is knowing how to apply Level II modifiers, defined as HCPCS/national modifiers comprising two alphabetic or alphanumeric digits. They are recognized by carriers nationally and are updated annually by CMS.
Modifiers for Monitored Anesthesia Care (MAC)  
Kelly Dennis, CPC, of Central Florida Anesthesia Associates of Leesburg, Fla., and president of the Florida Anesthesia Administrators Association, notes, When modifiers -G8 and -G9 first came out in 1999, it appeared as if they were for surgical reporting. After calling our local Medicare carrier, First Coast Options, I learned we do report these modifiers with our anesthesia codes."
Using Modifier -G8  
-G8 -- monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure.
 
 
Dennis states that this modifier is appended to the anesthesia code associated with the surgical procedure. These include:
  00100 -- anesthesia for procedures on salivary glands, including biopsy

00160 -- anesthesia for procedures on nose and accessory sinuses; not otherwise specified
 
00300 -- anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified
 
00400 -- anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified
 
00532 -- anesthesia for access to central venous circulation
 
00920 -- anesthesia for procedures on male genitalia (including open urethral procedures); not otherwise specified.
 
Dennis says, "A common example involves breast biopsy. If one of our anesthesiologists personally performs the procedure, it is common for us to report it as 00400-AA-G8." Deborah Hecht, CCSP, assistant administrator with Professional Anesthesia Services of Akron, Ohio, adds that Ohio and West Virginia's Medicare carrier, Nationwide Medicare, also uses this modifier. "The implementation of modifier -G8 has saved us a lot of headaches, especially with getting breast biopsy claims paid," Hecht says.
Using Modifier -G9  
-G9 -- monitored anesthesia care for patient who has history of severe cardiopulmonary condition.  
This modifier is more straightforward. In an LMRP regarding MAC, Nationwide Medicare states, "Use modifier -G9 in conjunction with the appropriate CPT code to denote any surgical procedure in which MAC is used when the patient has or had a severe cardiopulmonary condition, or there is [...]