Anesthesia Coding Alert

Modifiers give more details, but not extra pay.

Your monitored anesthesia care (MAC) coding just got a little more complicated: Some payers -- such as CMS contractor NHIC -- recently posted updated anesthesia billing guidelines, leading coders to question how to report the modifiers with MAC. If you're wondering how to proceed, pair our experts' advice with your local policies for fail-proof MAC modifier coding.

Use 3 Examples to Apply MAC Modifiers

When your anesthesiologist provides MAC, you'll report the anesthesia service code as usual, plus the appropriate MAC modifier (or modifiers, in some cases). Your choices include:

• Modifier G8 -- Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure
• Modifier G9 -- Monitored anesthesia care for patient who has history of severe cardiopulmonary condition
• Modifier QS -- Monitored anesthesia care service.

"QS is the modifier you use unless you have special circumstances for G8 or G9," explains Ellie-Ann J. Marchese, CCS-P, CANPC, coding supervisor at Suffolk Anesthesiology Associates, PC, in Smithtown, N.Y. "However, there are so many carriers with their own policies you need to check with each one to know whether they recognize MAC modifiers."

If your carrier requires MAC modifiers, always append modifier QS to the anesthesia code. If your carrier requires G8 and/or G9 modifiers, you should report those rather than the QS when needed.

Example 1: Mr. James is scheduled for an MRI. He has taken diazepam (Valium) to manage his agoraphobia (300.21, Agoraphobia with panic disorder, or 300.22, Agoraphobia without mention of panic attacks) for two years. His insurer agrees that administering MAC during the MRI will help Mr. James better tolerate the procedure, so approves youranesthesiologist's involvement. You'll report the anesthesia with 01922 (Anesthesia for non-invasive imaging or radiation therapy) and append modifier QS.

Example 2: Your anesthesiologist personally administers MAC during Mrs. Smith's breast biopsy. You'll submit 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) for the procedure and append either modifier QS or G8. However, if Mrs. Smith had a history of cardiac issues (such as bypass surgery), you would append modifier G9. "Official" definitions of conditions that merit G8 can be hard to find, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. Physicians sometimes share the example that an invasive procedure that would be too painful without anesthesia qualifies for modifier G8.

Example 3: Physicians in some hospitals (primarily teaching facilities) perform vascular bypass procedures under MAC instead of general anesthesia due to patients' heart conditions. You'll include either modifier QS or G9 on the claim.

Check Other Details Supporting MAC

Carrier policies regarding MAC can vary, so always check your local guidelines before submitting claims. Two factors apply to all carriers, however:

Information only: QS, G8, and G9 are informational modifiers. They give the payer more details about the case, but don't increase or affect reimbursement.

Justification: Carriers have specific parameters for diagnoses that justify MAC during procedures. Documenting that patients take long-term medications (such as Mr. James in the example above) or that they have certain underlying conditions can support the use of MAC when it might not usually be necessary. Conditions supporting MAC can include morbid obesity (278.01), Alzheimer's disease (331.0), malignant essential hypertension (401.0), and many others. Always check the carrier's most recent guidelines to ensure you follow correctly.