Wiki Moderation Sedation during Colonoscopies and EGD's

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swilks99705

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When coding Outpatient Colonoscopies and EGD's are we to also code the MAC separately (99152, 99153; in this instance)? The sedation is inclusive to the procedure, correct? The CPT description for the procedure(s) doesn't say to code the sedation separately and to my knowledge the sedation has always been included in the procedure code. No one wants a Colonoscopy while they're wide awake! 🙃 I am getting/seeing conflicting information from my fellow co-workers/coders and am on the hunt for clarification. When I coded these procedures in the past (for years and years....and years) we didn't code the Mod. Sed. out. This is the first facility that I have coded for where I've seen coders code the Mod. Sed. CPT's on the same encounter as the procedure itself. Just want to refresh my brain and ensure that I am coding the procedures correctly. Plus, I can't find anything, anywhere, that instructs me to code the MAC codes along with the procedure codes....HeLp! o_O TIA!
 
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MAC is Monitored Anesthesia that is administered by an anesthesia provider (ie, anesthesiologist or CRNA). When MAC is administered for colonoscopies and/or EGDs, we append the QS modifier. If your anesthesia providers are administering MAC anesthesia, I strongly suggest referring to your state's MAC LCD for co-morbidity diagnoses that justify the use of MAC and should be listed on your claim if documented.

99152, 99153 are for moderate sedation that is administered by the surgeon. These codes are not billed by anesthesia providers.

MAC and moderate sedation are not at all the same.
 
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LisaAlonso23 said:
MAC is Monitored Anesthesia that is administered by an anesthesia provider (ie, anesthesiologist or CRNA). When MAC is administered for colonoscopies and/or EGDs, we append the QS modifier. If your anesthesia providers are administering MAC anesthesia, I strongly suggest referring to your state's MAC LCD for co-morbidity diagnoses that justify the use of MAC and should be listed on your claim if documented.

99152, 99153 are for moderate sedation that is administered by the surgeon. These codes are not billed by anesthesia providers.

MAC and moderate sedation are not at all the same.
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The only things I'd add to this comprehensive answer are that the concept of moderate sedation being included in wide range of procedures (I think that was Appendix G?) was eliminated a few years ago. The only time it is included is if it is in the procedure code's descriptor.
Medicare has a G code for moderate sedation in conjunction with colonoscopy by the surgeon that would be reported in lieu of 99152.
 
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