Anesthesia Coding Alert

Question: I've been told that if the practitioner uses propofol, it constitutes general anesthesia (even if the anesthesiologist or CRNA documents MAC [monitored anesthesia care]). Is this true (and legal)?


Arkansas Subscriber


 
Answer: Using propofol does not determine whether the practitioner administered general anesthesia or MAC.

According to Medicare guidelines, using propofol (V58.83, Encounter for therapeutic drug monitoring) during a MAC procedure deems it medically necessary. Some carriers report V58.83 on all MAC Medicare claims that require documentation of medical necessity.
 
You should append modifier -QS (Monitored anesthesia care service) to the procedure code and submit a paper claim with a copy of the anesthesia record. You would not code separately for the propofol because it is considered part of the service.