Anesthesia Coding Alert

Question: How should we code for monitored anesthesia care (MAC) without sedation by a physician? This provider who handled MAC started the patient’s IV and monitored vitals during the procedure, but did not administer any drugs/sedatives/medications. Another provider performed the procedure. Can we bill anything for our MAC physician? 

Illinois Subscriber

Answer:  The American Society of Anesthesiologists (ASA) has a statement outlining its position on monitored anesthesia care that it updates/reviews periodically. It can be found on the ASA website, in their annual Relative Value Guide, and other places. 

One part of the statement says that “during MAC, the anesthesiologist provides or medically directs a number of specific services, including but not limited to ...” A bulleted list of services follows, which includes administration of sedatives, analgesics, etc as necessary for patient safety. 

Just below that bullet list, it reads “MAC may include varying levels of sedation, analgesia, and anxiolysis as necessary. The provider of MAC must be prepared and qualified to convert to general anesthesia when necessary.” 

Because of the “including but not limited to” statements, some experts think you could actually bill for an anesthesiologist who monitors the patient but doesn’t actually administer any type of sedation/analgesia. If so, then our subscriber would report whatever anesthesia code is appropriate for the procedure performed. 

Caution: Verify this approach with the payer before submitting the claim.