• Set Yourself Up For Success Webinar

    October 6, 2021 at 2 PM Eastern/11 AM Pacific
    SDN and Osmosis are teaming up to help you get set up for success this school year! We'll be covering study tips, healthy habits, and meeting mentors.

    Register Now!

  • Funniest Story on the Job Contest Starts Now!

    Contest starts now and ends September 27th. Winner will receive a special user banner and $10 Amazon Gift card!

    JOIN NOW
  • Site Updates Coming Next Week

    Site updates are coming next week on Monday, Wednesday, and Friday. Click the button below to learn more!

    LEARN MORE

GI Billing Classification

2Fast2Des

to become No One, one must be PP slick
5+ Year Member
Jun 29, 2016
664
645
166
  1. Attending Physician
So Medicare and insurance companies don't seem to want to pay for healthy patients with no significant comorbidities, that sedation administered under by the proceduralists is acceptable in place of an anesthesiologist. How is this allowed\logical?

Do you guys classify GI cases as MAC or general? And does this make a difference in claim acceptance? I hate how we are told to classify as MAC, which no proceduralist or any one in the OR actually knows what it means, since we are basically doing a general without an airway.
 

dannyboy1

Full Member
10+ Year Member
Aug 11, 2008
1,082
1,349
276
  1. Attending Physician
Was told by the billing people that for ASA 2 or lower you only get reimbursed for MAC if there is documented obesity, OSA, documented difficult airway. For ASA 3 or greater you get reimbursed for MAC. For general anesthesia you get reimbursed regardless because by definition a patient getting GA needs an anesthesiologist present. Because of this we have been “encouraged” to document as GA whenever we use propofol because you probably went into GA at some point...
 
About the Ads

2Fast2Des

to become No One, one must be PP slick
5+ Year Member
Jun 29, 2016
664
645
166
  1. Attending Physician
Was told by the billing people that for ASA 2 or lower you only get reimbursed for MAC if there is documented obesity, OSA, documented difficult airway. For ASA 3 or greater you get reimbursed for MAC. For general anesthesia you get reimbursed regardless because by definition a patient getting GA needs an anesthesiologist present. Because of this we have been “encouraged” to document as GA whenever we use propofol because you probably went into GA at some point...

We have been told the opposite, that you'd be "that guy" if you are an outlier billing general while everyone else tows the MAC line, which I guess would open up to audit?

I wonder then, for healthy patients we don't get reimbursed? How do anesthesiologists working in a surgicenter survive if you're dealing with healthy people all day?
 
Last edited:

abolt18

Cool cool cool cool cool cool cool cool cool cool
7+ Year Member
Apr 24, 2012
3,536
2,867
226
  1. Resident [Any Field]
So Medicare and insurance companies don't seem to want to pay for healthy patients with no significant comorbidities, that sedation administered under by the proceduralists is acceptable in place of an anesthesiologist. How is this allowed\logical?

Do you guys classify GI cases as MAC or general? And does this make a difference in claim acceptance? I hate how we are told to classify as MAC, which no proceduralist or any one in the OR actually knows what it means, since we are basically doing a general without an airway.
So document it as a GA with nasal cannula.
 
  • Like
Reactions: 1 user
About the Ads

B-Bone

Attending
15+ Year Member
Jun 22, 2004
555
626
316
  1. Attending Physician
medicare changed their stance on anesthesia for routine endoscopy in 2014, and most payors followed suit. Prior to that, medicare and most payors required patients to meet certain criteria to pay for anesthesia (ASA3, documented anxiety disorder, failed scope under RN sedation, etc). This article provides a nice summary of the current situation:

Anesthesia for Endoscopy: Economics 101 | Anesthesia Business Consultants
 
  • Like
Reactions: 1 users
D

deleted162650

You do ASA 1s and 2s? What do you use for medical necessity? Anxiety disorder?

The GIs are the ones that fill out the form.
Anxiety is a common one. Other popular indications in the ASA 1-2 crowd include: history of substance/EtOH use, prior attempt at procedure unsuccessful without anesthesia, hypertensive heart disease, metabolic disorder (hypothyroid or controlled DM), and even “screening colonoscopy” is an indication for some reason.
 

nimbus

Member
15+ Year Member
Jan 14, 2006
7,630
10,952
326
The GIs are the ones that fill out the form.
Anxiety is a common one. Other popular indications in the ASA 1-2 crowd include: history of substance/EtOH use, prior attempt at procedure unsuccessful without anesthesia, hypertensive heart disease, metabolic disorder (hypothyroid or controlled DM), and even “screening colonoscopy” is an indication for some reason.

We provide anesthesia for many of the same indications but it’s usually 1 or 2 cases in a lineup of 8-10. The rest the patients get sedation by the nurse. We never do the whole list.
 

anbuitachi

Full Member
10+ Year Member
Oct 26, 2008
5,788
2,726
276
Utah
  1. Attending Physician
i dont know about billing but i remember putting General as case type when i do my endoscopies.. because they are technically general cases without a tube.

Also ive heard several GI people say they prefer to have us there and use propofol because it provides 'better conditions'

in my previous hospital every endo/colon gets anesthesiologist

now at current hospital on east coast they are all done by nurse giving sedation. i wonder how much they give for a endoscopy and how long it takes to provide sedation before procedure start. i remember 1 instance in the past year where we were paged stat to teh endoscopy room because the patient kept on moving even after 4 of midaz and 250 of fentanyl given by nurse. they 'requested propofol'.
 

Zekchar

Full Member
2+ Year Member
Mar 10, 2019
174
472
116
  1. Attending Physician
This came up at a buddy of mines institution. They do lots of endo / colons with 3:1 CRNA:Attending ratios. They were instructed by the department heads to call it MAC. I personally believe it is a general anesthetic but I wasn't asked. Case closed.
 

UscGhost

Full Member
2+ Year Member
Jan 2, 2018
76
128
116
Side question since we're talking about big mac. For EGD in a patient with poorly controlled GERD/reflux, do you tend to lean towards GA (tube) or MAC?


MAC.

Only consider doing geta in patients with food impaction, massive GI bleed, maybe a couple other rare scenarios

Depends a bit on how skilled your GI docs are. Havent intubated a GI case in 6 years
 
  • Like
Reactions: 1 user

AdmiralChz

Full Member
10+ Year Member
Sep 8, 2008
3,774
3,734
276
Mid-Atlantic
  1. Attending Physician
It’s mostly semantics, but calling it a MAC (versus a general) allows our GI RNs to recover the patients themselves versus head to PACU. If it’s checked “General” that would crush the workflow at our hospitals. These folks are of course awake and oriented faster than your typical GA in the OR, that makes a huge difference in recovery.

it was my understanding that certain states / insurance carriers require the medical necessity form. Mine doesn’t, but we do the form anyway. That also might be old news - to my knowledge we never have trouble billing in GI. But we only do about 10% or so ASA 1s and 2s.

As far as intubations, NEVER for severe GERD (a frequent EGD indication) alone. As above said - food bolus (if it’s upper obstruction, and you know!), some ERCPs (doc preference), and odd-ball advanced endoscopies (Spirus enteroscopy sometimes, pancreatic necrosectomies).

Also of note - I don’t work at a place with a GI fellowship. We intubated many more endoscopies in residency for this reason. Our docs here are all pretty slick.
 

jwk

CAA, ASA-PAC Contributor
15+ Year Member
Apr 30, 2004
3,849
1,276
326
Atlanta, GA
It’s mostly semantics, but calling it a MAC (versus a general) allows our GI RNs to recover the patients themselves versus head to PACU. If it’s checked “General” that would crush the workflow at our hospitals. These folks are of course awake and oriented faster than your typical GA in the OR, that makes a huge difference in recovery.
GI RNs should be able to handle GA patients. We do many of our ERCPs under GA - they stay in the GI PACU.
 
About the Ads
This thread is more than 1 year old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.