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Anesthesia Coding Alert

Reader Questions:

Verify Diagnosis to Justify MAC

Published on Thu Sep 09, 2004

Question: Our anesthesiologist provided MAC (monitored anesthesia care) during lumbar radiofrequency ligation. He classified the patient as P3 (A patient with severe systemic disease) with a diagnosis of lumbar radiculopathy. High blood pressure is the only indication I have to support MAC. Do you have any advice?

Texas Subscriber Answer: As of October 2003, Texas Medicare allows 401.9 (Essential hypertension; unspecified) as a diagnosis supporting MAC necessity. Any other information you can glean from the patient's history and physical that supports the P3 status will help your justification.
 
Code the anesthesia as 00630 (Anesthesia for procedures in lumbar region; not otherwise specified) with diagnoses 401.9 and 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified) or any other diagnosis that helps justify MAC (ask the physician for a more specific hypertension diagnosis if possible so you don't have to report an "unspecified" code).
 
Also include modifiers -AA (Anesthesia services performed personally by anesthesiologist) and -QS (Monitored anesthesia care service) to indicate the physician provided MAC service.
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