Nugget: Knowing which type of anesthesia is providednot just the type that is plannedis the key to reimbursement.
Anesthesiologists sometimes need to change the anesthesia plan due to complications with the patient or procedure. Even if monitored Anesthesia care (MAC) is planned for a procedure and is initially offered, that may change before the procedure ends. If an anesthesiologist crosses over from providing MAC to providing regional or general anesthesia, the change must be documented for proper reimbursement.
You never know how a patient will respond to anesthesia, points out Cindie Capito, physician
Anesthesia coder for Southern Tier Anesthesiologists, PC, an Olean, N.Y., practice with nine physicians and seven CRNAs. Sometimes the anesthesia plan needs to change because complications will come up.
One such complication is when the patient needs assistance breathing, Capito says. If the level of MAC is so deep and complex that the anesthesia provider has to assist the patients breathing, then we consider it general anesthesia. If we have to breathe for the patient for a few seconds, we still consider it as a MAC case. But if we need to breathe for the patient for two or three minutes or more, we see it as crossing the line to general anesthesia. The anesthesiologist must document this in the patients chart by noting that the patient needed assisted breathing with a mask, or placement of an LMA (laryngeal mask airway) or a COPA (cuffed oral pharyngeal airway). The length of time the assistance is needed should also be noted on the patients chart.
Capitos guidelines are consistent with the American Society of Anesthesiologists (ASA) definition. The 1999 Relative Value Guide reads, Monitored anesthesia care refers to those clinical 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 normal protective reflexes, then anesthesia care shall be considered a general anesthetic.
Coding for the Right Type
Even if there is not a change in the anesthesia plan, for reimbursement, anethesiologists must thoroughly document whether the anesthesia administered is MAC, general or regional. Joyce Lujic, an office manager with the 16-physician group Anesthesia Associates of New Haven in Connecticut, gives these examples of three procedures that could be treated with MAC or general/regional care, depending on the situation:
A CRNA provides anesthesia during a breast tumor excision under the medical direction of a physician. If MAC is provided, the case would be coded as 19120 (for the tumor excision) -QS (MAC) -QX (CRNA service: with medical direction by a physician). If the local carrier requires the new MAC modifiers, modifier -G8 (MAC for deep complex, [...]
