General versus MAC: What’s More Appropriate for GI?
Summary: While there is virtually no difference in payment success for general versus MAC GI cases, some anesthesia providers continue to document MAC—even where the patient loses consciousness. Today's article addresses the difference between these two anesthesia types and their current applications and implications in gastrointestinal cases.
A number of years ago, the ASA modified its definition of general anesthesia. Historically, if a patient was unconscious or could not respond purposefully for the preponderance of the case, it was considered a general anesthetic (GA). This language was later revised so that the current standard is that if a patient loses consciousness or is unable to respond purposefully for any portion of the case, the anesthesia type is automatically deemed to be GA.
While we at ABC have consistently explained this change during client in-services and suggested to our clients that they document their anesthesia type consistent with ASA guidelines, this advice has met with a variety of reactions; and the results pose an interesting case study in what appears to be a somewhat sensitive topic for anesthesia providers, especially for endoscopic cases.
Comparing the Numbers
The chart below shows the percentage of endoscopic cases billed as GA versus MAC for a sample of 50 client groups. These groups are distributed across the country and represent a mix of physician-only and care-team practices. Some cases are administered on an inpatient basis, but most are outpatient cases. All clients have received the same guidance from ABC.