Your anesthesiologist is having a tough time getting Medicare reimbursement for Monitored Anesthesia Care (MAC) for endoscopy procedures. Here you need to consider “medical necessity”.
Here’s what you need to do when you encounter such situations:
First of all establish “medical necessity” for endoscopy. According to Centers for Medicare and Medicaid Services (CMS), endoscopic procedures are covered when required for the individual patient.
Situations that establish the medical necessity for endoscopic procedures are patients who have more complex procedures like endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS); patients who are suffering from cancer, children who are 18 years or younger, seniors over 65 years, among others.
Secondly, the patient should have a medical condition significant enough to impact the need to provide MAC.
Lastly cite circumstances for endoscopy. Your anesthesiologist’s documentation must explain the circumstances under which the service was provided. It’s essential that your anesthesiologist along with the endoscopist keep a record of these indications in their individual documents. Remember that the supporting document should identify patient-specific reasons for MAC.
Right now there’s no national policy for anesthesia and endoscopy; as such, it is highly important to know your local carrier policies in relation to reimbursement.
To get more insight on MAC and other anesthesia coding know how, attend anesthesia coding seminars and conferences and get your payments right.
In fact, just two months on, there’s an anesthesia coding conference taking place in Orlando, FL where you can head to and get to know all that you need to know about your specialty. This is a sure-shot way to beat your competitors and how!