Understanding the Difference Between TIVA & MAC: Tips for Easy Reimbursement

Anesthesia care and billing doesn’t fall on a spectrum from “easy to hard” in terms of levels of care. In fact, it’s a diverse Venn diagram of interactions between existing conditions, procedures, modifiers, and services. The distinctions on this Venn diagram become very important, however, when it comes time to reimburse for these complex types of anesthesia care. 

 

Anesthesia Care: TIVA vs. MAC

So, what are some of the differences between TIVA and MAC? 

TIVA MAC
Total Intravenous Anesthesia  Monitored Anesthesia Care
Patient is intubated – airway is managed via laryngeal mask. Patient is not intubated – airway is not secured.
Anesthesia is not inhaled, but administered intravenously. Anesthesia is inhaled and combined with local anesthesia.
Patient is unconscious during procedure. Patient typically does not fully lose consciousness.
Higher instances of PONV (post-operative nausea and vomiting). Lower PONV and quicker patient recovery times.
Preferred for lengthier or more complicated procedures. Great flexibility to tailor to the needs of the patient.

 

Both of these types of care have different CPT billing codes, not because of the degree of difficulty involved, but as a way to acknowledge the different types of anesthesia practice required for each one. The reimbursement is calculated as follows: 

Base Units Assigned to the Procedure X Local Conversion Factor + Anesthesia Time = Your Reimbursement

 

Read more about calculating anesthesia time units! 

 

The same case, billed as either a TIVA or a MAC, will be reimbursed at the same rate as long as you use the same modifier. Even if the surgeon decides to switch anesthesia types mid-procedure, you can still reimburse at the appropriate rate, as long as you thoroughly document your technique. If the surgeon rotates the operating table 90 to better access the operation site, document this. Even if you physically didn’t change the patient’s orientation, this change should still be noted as any change can affect the administration of anesthesia. If there is field avoidance, document this! The better your documentation of your procedure, the more likely you will be able to add additional base units to your reimbursement. 

Know Your Payers Policies

Also, it’s always important to know your payer’s policies in detail. Some policies may not allow certain modifiers for certain procedures, so it’s important to make sure you know what is allowed before you put through your claims. Most will differentiate between cases involving TIVA and cases involving MAC, however. 

If you need help staying up-to-date with CPT codes and billing best practices, don’t hesitate to reach out to us by phone, email, or contact form