Anesthesia Coding Alert

Question: I’m new to anesthesia coding and have heard quite a bit about monitored anesthesia care. What is the code for MAC?

Oklahoma Subscriber

Answer: The CPT^® manual does not include a specific code for monitored anesthesia care (MAC) because MAC is not a procedure. Instead, MAC is a type of anesthesia that your provider might use in certain situations.

Conscious sedation and monitored anesthesia care refer to an awareness somewhere in the middle of the spectrum depending on the degree to which a patient is sedated. It is important to note that awareness/wakefulness is not necessarily correlated with pain or discomfort. The aim of conscious sedation or monitored anesthetic care is to provide a safe and comfortable anesthetic while maintaining the patient’s ability to follow commands. Under certain circumstances, a general anesthetic, whereby the patient is completely unconscious, may be unnecessary and/or undesirable. For instance, with a cesarean delivery, the goal is to provide comfort with neuraxial anesthetic yet maintain consciousness so that the mother can participate in the birth of her child. Other circumstances may include, but are not limited to, procedures that are minimally invasive or purely diagnostic (and thus not uncomfortable). Sometimes, the patient’s health may not tolerate the stress of general anesthesia. The decision to provide monitored anesthesia care versus general anesthesia can be complex involving careful consideration of individual circumstances and after discussion with the patient as to their preferences.

Patients who undergo conscious sedation or monitored anesthesia care are never meant to be without recall. Whether or not a patient remembers the procedure depends on the type of medications used, the dosages used, patient physiology, and other factors. Many patients undergoing monitored anesthesia care do not remember the experience.

Also: There is no code for MAC, but there is a modifier associated with the service: modifier QS (Monitored anesthesia care service). Include modifier QS on claims that involve MAC, listed after the modifiers representing which anesthesia provider performed the service (AA, QZ, etc.), and before the physical status modifier (P1, P2, etc.). Depending on your Medicare Administrative Contractor, you may also need to report modifier G8 (Monitored anesthesia care for deep complex, complicated or markedly invasive surgical procedure or G9 (MAC for patient who has history of severe cardio-pulmonary condition), depending on the patient’s medical history.