Anesthesia Coding Alert

Question: A patient had transthoracic echocardiography under MAC due to Down syndrome and autistic disorder. I have documentation for reporting 93303 for the procedure but am not sure of the correct anesthesia code and whether it needs a special modifier. What do you recommend?

Connecticut Subscriber

Answer: Procedure 93303 (Transthoracic echocardiography for congenital cardiac anomalies; complete) crosses to anesthesia code 01922 (Anesthesia for non-invasive imaging or radiation therapy). Append modifier QS (Monitored anesthesia care service) to 01922 to designate monitored anesthesia care (MAC).

Pay attention: Although your provider administered anesthesia during a procedure that usually does not require it, do not append modifier 23 (Unusual anesthesia) to the claim. Modifier 23 only pertains to cases utilizing general anesthesia, not MAC.

Submit the primary diagnosis necessitating the procedure and report the most appropriate options for Down syndrome and autistic disorder as second and third diagnoses. Those might include Q90.9 (Down syndrome, unspecified) or F84.0 (Autistic disorder), depending on the circumstances. Also include clear documentation of the surgeon’s request for anesthesia and why it was medically necessary since most patients don’t need anesthesia during this procedure.