Anesthesia Coding Alert

Long-term use can help justify MAC Details about a patient's medication history -- specifically his use of high-risk medications -- can help justify anesthesia in nonstandard cases. Read on for expert advice on how to put this knowledge to work for you. Pay Close Attention to High-Risk Meds All medications fall into risk-level categories. The challenge for you as a coder is to train your physicians to list all of a patient's medications on the chart so you can determine if any affect your coding.

-Oftentimes, providers neglect to tell us about a patient's underlying conditions,- says Leslie Johnson, CCS-P, CPC, of River Oaks Imaging and Diagnostics in Houston. -But they almost never neglect to tell us the names of medications the patient currently takes.- 

Once you know what medications a patient takes, pay close attention to the ones considered to be high-risk (including Vicodin, Percocet, Oxycontin, Valium and others). Then find out how long the patient has taken the high-risk medication, and get ready to submit claims for services you might otherwise not be able to file. Long-Term Use Can Justify MAC ICD-9 includes several codes for long-term (current) drug use. Code V58.69 (Long-term [current] use of other medications) includes high-risk medications and can be your ticket to more accurate coding and reimbursement.

Example 1: Mrs. Jones is scheduled for an MRI. She's very anxious about feeling claustrophobic, so the radiologist asks your physician to administer MAC (monitored anesthesia care) during the procedure to help her relax. Mrs. Jones- carrier denies reimbursement, saying the anesthesia is not justified. 

On the other hand, Mr. Brown is also scheduled for an MRI. He has taken diazepam (Valium) to manage his agoraphobia (300.20, Phobia, unspecified) for three years. His carrier agrees that administering MAC during the MRI will help Mr. Brown tolerate the procedure, so approves your anesthesiologist's involvement. In this case, report the anesthesia with 01922 (Anesthesia for non-invasive imaging or radiation therapy) and append modifier QS (Monitored anesthesia care service).

Example 2: Physicians in some hospitals (primarily teaching facilities) are beginning to perform vascular bypass procedures under MAC instead of general anesthesia due to patients- heart conditions. Because these patients typically take long-term medications and have underlying conditions to justify MAC, the carrier should reimburse your anesthesiologist.

Note: In this case, remember to append modifier G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition) to the anesthesia code in addition to modifier QS.  Defining -Long-Term- Can Be Tricky Once you know that the patient takes a high-risk medication, the next question to ask is, -What constitutes long-term use?-

The answer is a definite gray area because no official guidelines exist to define -long-term.-

-Medicare wants to know [...]