Anesthesia Coding Alert

Question: I have recently learned about G8 and G9 modifiers. How do I know whether Medicare requires reporting these, and how do I know when they will apply?

Kentucky Subscriber

Answer: First, let’s look at the descriptors for these monitored anesthesia care modifiers:

• Modifier G8 (Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure)
• Modifier G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition).

The Medicare carrier for your state, CGS, has not published either a requirement or a Local Coverage Determination (LCD) requiring the use of these modifiers. To better understand when they will apply, look at an LCD from another Medicare carrier that does have this policy such as Novitas. Their LCD indicates the following:

The use of anesthesia modifiers, when the CPT code is not fully descriptive, is required as follows:

• G8 anesthesia modifier – used to indicate certain deep, complex, complicated or markedly invasive surgical procedures. This modifier is to be applied to the following anesthesia codes only: 00100, 00300, 00400, 00160, 00532, and 00920.
• G9 anesthesia modifier – represents “a history of severe cardiopulmonary disease” and should be utilized whenever the proceduralist feels the need for MAC due to a history of advanced cardiopulmonary disease. The documentation of this clinical decision-making process and the need for additional monitoring must be clearly documented in the medical record.

G8 and G9 are valid modifiers and should be paid as normal if they are reported, regardless of whether it’s required. If there is no requirement to report, modifier QS (Monitored anesthesia care service) is sufficient to indicate the type of anesthesia.

Resource

https://cgsmedicare.com/partb/specialty/index.html#.

www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35049.