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Correctly Code Monitored Anesthesia Care (MAC) for Endoscopy Procedures

Posted on 20. Apr, 2009 by in Hot Coding Topics

Establish dual necessity to unlock MAC reimbursement.

If your anesthesiologist is having trouble getting Medicare reimbursement for monitored anesthesia care (MAC) for endoscopy procedures, it might be time to clarify exactly what is meant by “medical necessity.”

AUDIO: Secrets to Getting Paid for Endoscopic Anesthesia, April 21, 2009. Can’t make it? Buy the CD instead.

Medicare defines “medical necessity” as services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Under the Social Security Act, CMS determines on a case-by-case basis if the method of treating a patient is reasonable and necessary. Even if a service is reasonable and necessary, coverage may be limited or denied if it is provided more frequently than allowed under a coverage policy, or as accepted standard of practice.

First: Establish Necessity for...

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