Anesthesia Coding Alert

Answer: MAC is monitored anesthesia that is administered by an anesthesia provider (i.e., anesthesiologist or CRNA).

The concept of moderate sedation being included in wide range of procedures is no longer in effect. The only time it is included is if it is in the procedure code’s descriptor.

Moderate sedation codes fall into two groups: codes reported by providers who administer the sedation and perform the service and codes reported by providers who administer the sedation when a different provider performs the service.

Anesthesia providers will be working with others who perform the procedure, so your code choices are:

• 99155 (Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age)
• 99156 (… initial 15 minutes of intraservice time, patient age 5 years or older)
• +99157 (… each additional 15 minutes intraservice time (List separately in addition to code for primary service)).

When a provider administers MAC for colonoscopies and/ or EGDs, append modifier QS (Monitored anesthesia care service), G8 (Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure), or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition) as appropriate.

Final tip: Refer to your state’s MAC LCD for co-morbidity diagnoses that justify the use of MAC. Include these on your claim if the provider documents them.