Part B Insider (Multispecialty) Coding Alert

Lean On Long-Term Use Codes For Monitored Anesthesia Care

Question: If a patient takes high-risk medication and needs to receive anesthesia, what code would I use to justify the long-term drug use?


Iowa Subscriber

Answer: First, remember that ICD-9 includes several codes for long-term (current) drug use. Code V58.69 (Long-term [current] use of other medications) includes high-risk medications and can be your ticket to more accurate coding and reimbursement.

Example: Say that a patient is scheduled for an MRI. He has taken diazepam (Valium) to manage his agoraphobia (300.20, Phobia, unspecified) for the past three years. Medicare agrees that administering monitored anesthesia care (MAC) during the MRI will help the patient tolerate the procedure, so it approves your anesthesiologist's involvement. In this case, report the anesthesia with code [01922 (Anesthesia for non-invasive imaging or radiation therapy) and append modifier QS (Monitored anesthesia care service).

Important: "Medicare wants to know how long the patient has been on the medication, but you just have to take the patient's word for it," says Leslie Johnson, CCS-P, CPC, of River Oaks Imaging and Diagnostics in Houston. The anesthesia record won't reflect this information, reminds Kelly Dennis, CPC, owner of the consulting firm Perfect Office Solutions in Leesburg, FL. Instead, you'll typically find these details in the pre-anesthesia evaluation or assessment form.

Helpful: Many in-the-trenches coders agree that high-risk medications taken for one year or longer should constitute long-term use. Because no official guidelines are in place for these situations, watch for these medications and talk with your physicians and carriers to determine when medications will help justify MAC for procedures.