Anesthesia Coding Alert

Tip: Don't forget to study updated ASA guidelines

Surgeons often request anesthesia for patients' comfort - as often is the case during a GI endoscopy. But many of these cases that coders routinely report as monitored anesthesia care (MAC) now qualify as general anesthesia based on the newest definition given by the American Society of Anesthesiologists (ASA). Be sure you're up to speed with the definitions before reporting anesthesia.

An article in the June 2004 ASA newsletter provided additional clarification of the 1998 Position Statement on Monitored Anesthesia Care:

"Monitored anesthesia care often includes the administration of doses of medications for which the loss of normal protective reflexes or loss of consciousness is likely. Monitored anesthesia care refers to those situations in which the patient remains able to protect the airway for the majority of the procedure. If, for an extended period of time, the patient is rendered unconscious and/or loses protective reflexes, then anesthesia care shall be considered a general anesthetic."

Providers - and carriers - have trouble defining vague terms such as "extended period of time" and "majority of the procedure." This challenge prompted ASA's clarification that changes the final sentence of the MAC Position Statement.

The policy now reads, "If the patient loses consciousness and the ability to respond purposefully, the anesthesia care is a general anesthetic, irrespective of whether airway instrumentation is required."

Because of these changes, coders such as Samantha Mullins, CPC, MCS-P, manager of coding and compliance for VitalMed Inc. in Birmingham, Ala., say that the frequency of MAC procedures has decreased. This leads to fewer rejections based on the MAC policies some carriers have in place.

"It has also caused a change in anesthesia policies," Mullins says. "Some carriers are working on - or may have already implemented - procedure-specific policies for colonoscopy, EGD and other procedures in place of the MAC-specific policies."