Anesthesia Coding Alert

Question: Our state requires that we use modifier -G8 (Monitored anesthesia care [MAC] for deep complex, complicated or markedly invasive surgical procedure) when appropriate with MAC cases, but it's denied as an invalid modifier with code 01820 (Anesthesia for all closed procedures on radius, ulna, wrist or hand bones), although the patient had no other problems and was having an external fixation device removed (which is a markedly invasive procedure). Reporting with modifier -QS (Monitored anesthesia care service) was also denied for medical necessity without a coexisting condition. How should we code these cases?

California Subscriber

Answer: Some states that require use of modifiers -G8 and -G9 (Monitored anesthesia care for patient who has history of severe cardiopulmonary condition) say they are only required for specific codes. For example, Florida only requires -G8 for cases reported with codes 00160 (Anesthesia for procedures on nose and accessory sinuses; not otherwise specified), 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck and posterior trunk, not otherwise specified), 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified), 00532 (Anesthesia for access to central venous circulation) and 00920 (Anesthesia for procedures on male genitalia [including open urethral procedures]; not otherwise specified).

Code 00100 (Anesthesia for procedures on salivary glands, including biopsy) may be included on some states' lists, but Florida removed it. Verify which codes your local carrier requires -G8 for. If the procedure in question isn't on that list, use modifier -QS with a diagnosis code supporting medical necessity (such as 515, Postinflam-matory pulmonary fibrosis, or 414.00, Coronary atherosclerosis; of unspecified type of vessel, native or graft).