Question

A 74 year-old patient is undergoing surgery under monitored anesthesia care (MAC). The surgeon has determined the procedure will be markedly invasive. What modifier(s) is/are appropriate for Medicare?

a) QS
b) G8
c) G9
d) G8 and QS

Answer 1

The correct modifier for the described scenario is G8, used to indicate a markedly invasive procedure requiring complex post-operative monitoring and management for Medicare billing.

Step-by-step explanation:

The modifiers used in billing to Medicare significantly impact reimbursement and compliance. For a 74-year-old patient undergoing a markedly invasive procedure under monitored anesthesia care (MAC), the appropriate modifier to use is G8. This modifier is used to indicate that the procedure is expected to require a complex and time-consuming post-operative monitoring and management due to the patient's underlying conditions, which are expected to complicate anesthesia care. Since the scenario involves a markedly invasive procedure, a QS modifier is not necessary as it is generally used for procedures that require a qualitative or quantitative assessment of the sedation level.

Thus, the correct answer to the question is option b) G8. During the pre-operative phase, all team members involved in the care of the patient, such as the surgeon, nurse, and anesthesia professional, must review the key concerns for the recovery and patient care.