Anesthesia Coding Alert

Question: What will be the correct PQRS codes (Measure #193) for cataract surgery using MAC anesthesia that we report with code 00142?

Kansas Subscriber

Answer:  You’ll need at least two codes on the claim whenever you report measure 193, except when the case is less than one hour. The first code, known as the numerator, is a Category II code that represents the measure. The second, or denominator, is the applicable anesthesia code. The numerator options include:

• 4250F – Active warming used intraoperatively for the purpose of maintaining normothemia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time (CRIT) 
  
• 4255F – Duration of general or neuraxial anesthesia 60 minutes or longer, as documented in the anesthesia record (CRIT) (Peri2). 
  

Note: Code 4256F (Duration of general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record. [CRIT] [Peri2]) used to be another numerator option, but is no longer valid as of Jan. 1, 2015, according to the American Society of Anesthesiologists. 

When a case doesn’t meet the code criteria because of anesthesia technique or not reaching the required temperature, append a modifier for explanation. Your two choices are:

• Modifier 1P – Intentional hypothermia OR active warming not indicated due to anesthetic technique: peripheral nerve block without general anesthesia, OR monitored anesthesia care 
  
• Modifier 8P – Active warming not performed OR at least one body temperature equal to or greater than 36 degrees Centigrade not achieved within designated time frame, reason not otherwise specified.

You may also need to submit one of two G codes to further explain the situation. The possible codes are G9362 (Duration of monitored anesthesia care [MAC] or peripheral nerve block [PNB] without the use of general anesthesia during an applicable procedure 60 minutes or longer, as documented in the anesthesia record) or G9363 (Duration of monitored anesthesia care [MAC] or peripheral nerve block [PNB] without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record). Cataract cases normally last less than an hour, which means you probably will report G9363 more often than G9362 for these patients.