While anesthesia providers have only three modes to report to payers, one seems to cause a lot of confusion among professionals, according to a July 3 blog post from Rita Astani, president of anesthesia for Coronis Health.
Monitored anesthesia care was introduced in 1986 to improve the previous term, "anesthesia standby." It was intended to define the clinical situation where a patient's medical status required an anesthesia provider to monitor a patient's health throughout the entire procedure.
Medicare assigned a new modifier for MAC procedures, though it did not impact the rate of payment. All modes of anesthesia are paid at the same rate.
In the 1980s, patients undergoing screening colonoscopies became entitled to anesthesia, not incurring any responsibility from their deductible or coinsurance if the colon turned out to be normal.
For most anesthesia practices, endoscopy has become the fastest growing and most profitable business line. Many providers earn 30 percent of their revenue from endoscopy, Ms. Astani wrote.
The anesthesia used for endoscopic procedures fits the current definition of general anesthesia, but many providers continue to bill it as MAC. Even though the payment rate is the same, Ms. Astani said Coronis Health encourages providers to bill these procedures as GA when allowed, in part because using MAC may understate the value of the service.
While endoscopy is profitable for practices, some insurers are starting to push back against anesthesia coverage for certain patients due to the rise in claims. As billing gets more complicated for these procedures, payers are once again looking at a new fight over submitted claims, Ms. Astani said.