Anesthesia Coding Alert

Question: Our anesthesiologist administered monitored anesthesia care (MAC) while the surgeon performed transesophageal echocardiography (TEE) with cardioversion. What modifier should we use for Medicare when the procedure code says it includes moderate sedation?

Texas Subscriber

Answer: You should typically include modifier QS (Monitored anesthesia care service) on your claim. Check your carrier's guidelines for other MAC modifier usage and details of the patient's history because you might also need to report G9 (Monitored anesthesia care [MAC] for patient who has history of severe cardiopulmonary condition).

Tip: Sedation is what the operating-room surgeon or non-anesthesiologist performs on a patient for his comfort. TEE, like endoscopy, includes sedation as part of its global fee. In certain circumstances, however, sedation might not be adequate, or the patient's age or comorbidities might warrant having an anesthesiologist present during the case. You'll need documentation supporting the reasons for your anesthesiologist's presence to explain the situation to your carrier.