Anesthesia Coding Alert

Question: We have a physician who wants to perform monitored anesthesia care (MAC) during pain injection procedures. Is this billable?

Wyoming Subscriber

 
Answer: Most carriers would question the medical necessity of providing MAC during pain injections. However, administration of anesthesia by an anesthesiologist or certified registered nurse anesthetist (CRNA) may be payable under Medicare when a patient is unstable (ASA class 4 or 5), confused, has extreme pain, is unable to remain completely immobile, combative, or extremely anxious or has any other problem that deters from performing the procedure. Your carrier will probably ask for a statement (signed by the physician) noting these qualifying circumstances. If there are no qualifying circumstances, and the physician and the patient agree to MAC during treatment, they should decide who will pay for the anesthesia. In some situations, it may be appropriate to have the patient sign a waiver of liability, and append modifier -GA (Waiver of liability statement on file) to the anesthesia procedure code.

 
Responses to You Be the Coder and Reader Questions provided by Kelly Dennis, CPC, of Central Florida Anesthesia Associates in Leesburg, president of the Florida Anesthesia Administrators Association; and Barbara Johnson, CPC, MPC, professional coder, Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif.