Anesthesia Coding Alert

Question: What diagnoses mandate the presence of an anesthesia provider during MAC sedation for such pain management procedures as epidural injections, facet injections and trigger point injections?

California Subscriber

Answer: Monitored anesthesia care (MAC) is usually not provided to patients undergoing trigger point injections, facets or epidural steroid injections. To be paid for MAC, medical necessity must be indicated which is difficult with these procedures because they rarely require the monitoring of vital signs.

MAC is typically provided to combative patients, those with low pain thresholds who suffer severe pain or those with severe health problems that require careful monitoring. A physician or a qualified individual under the medical direction of a physician performs the intra-operative monitoring and checks the patients vital signs in anticipation of the need for possible general anesthesia.

MAC is similar to global anesthesia because the patient is connected to equipment, and the procedure also includes a preoperative anesthesia evaluation and plan workup as well as a postoperative evaluation. Both must be performed and documented.

Finally, Medicare will only reimburse MAC if the physician is present in the operating suite.