Anesthesia Coding Alert

Question: What is MAC (monitored anesthesia care), and how is it different from general or regional anesthesia? Should I report MAC differently from other types of anesthesia?

Nebraska Subscriber

Answer: According to the "2003 Relative Value Guide" published by the American Society of Anesthesiologists, "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."
 
A patient with MAC, in other words, is sleepy but not unconscious.
 
A patient with general anesthesia is unconscious and totally dependent on the anesthesia provider for airway maintenance. The physician injects regional anesthetics into a particular area such as the shoulder or spine (although the injection numbs more than just the immediate area). The patient is either awake or asleep. The patient may have other drugs in addition to regional anesthesia and may even have a general anesthetic in addition to the regional.
 
In terms of coding differences, you must append modifier -QS (Monitored anesthesia care service) to any MAC claims with Medicare patients. Some states such as Florida also require modifiers -G8 (Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure) or -G9 (Monitored anesthesia care for patient who has history of severe cardiopulmonary condition) when appropriate.
 
Providing MAC is just as involved as general anesthesia, so it's reimbursed at the same rate if you meet the carrier's medical-necessity and documentation guidelines. Many carriers have specific guidelines about which diagnoses and procedures qualify for MAC, or have adopted CMS' guidelines for MAC reimbursement. Be familiar with your carriers' policies beforehand to ensure you meet their MAC criteria so they won't deny your payments.