Anesthesia Coding Alert

Question: Our carrier is denying MAC anesthesia for a colonoscopy. Do you have any thoughts on what I might be doing wrong? 


Kansas Subscriber

Answer: The physician performing the colonoscopy is usually responsible for the patient's sedation. To receive reimbursement for the anesthesiologist, your first step should be to verify you have a diagnosis that supports the medical necessity for anesthesia.

Acceptable diagnoses can vary by state, so check the local coverage determination for updated information. You should also print the policy for the gastroenterologist so he knows when you can and cannot be paid for anesthesia during the procedure. 

You Be the Coder and Reader Questions were answered by Cheryl Pascale, CCS, of Hackensack Anesthesiology in Hackensack, N.J.