Traditionally, MAC anesthesia cases and general anesthesia cases were very easy to differentiate. General anesthesia refers to patients that are completely asleep and have an endotracheal tube down the throat. MAC anesthesia (Monitored Anesthesia Care) refers to patients that are not completely asleep (various levels of sedation) and were not intubated.
Propofol and MAC Anesthesia
Propofol has completely changed the nomenclature.
Anesthesia is a continuum, not a designated “label” or “level”. Anxiolysis, light sedation, moderate sedation, deep sedation, general anesthesia.
General anesthesia by definition is when a patient loses their protective airway reflexes. When they are so sedated that they can no longer swallow saliva, gag reflex has been obtunded, may quit spontaneously breathing, and may obstruct easily.
MAC anesthesia by definition is when the patient receives varying levels of sedation to achieve ideal procedural conditions with patient interaction.
An anesthesia provider can give a little propofol and the patient will be amnestic, yet still have eyes open (awake). This by definition would be a MAC or light sedation. However, the anesthesia provider can give a larger dose of propofol and put patient completely asleep so a gastroenterologist can pass a scope into their stomach without the patient gagging or fighting, this by definition would be a general.
From our experience, most if not all endoscopy cases are really general anesthetics by definition.
MAC Anesthesia Reimbursements
According to the ASA relative value guide, the type of insurance should not impact reimbursements, however, many payors now have Monitored Anesthesia Care requirements. Understanding the difference between MAC and General allows the billing company to apply the correct anesthesia modifier and for the claims to be paid quickly and correctly.