00811 00812 for Medicare Colonoscopy Anesthesia Coding
When reporting anesthesia for a screening colonoscopy, the appropriate code is 00812 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy. When reporting 00812 for a Medicare beneficiary, Medicare will waive the deductible and coinsurance, for the patient.
On occasion, a service that begins as a screening colonoscopy will reveal the presence of a polyp or other neoplasm within the colon. When this occurs for a Medicare beneficiary, you should no longer report 00812 for anesthesia. Instead, per MLN Matters Number: MM10181, “When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia services are reported with CPT code 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscopy introduced distal to duodenum; not otherwise specified) and with the PT modifier [Colorectal cancer screening test screening test, converted to diagnostic test or other procedure].”
Medicare will pay claim lines with 00811, but will waive only the deductible when submitted with the modifier PT.
Note that the above instruction for use of 00811 when reporting services for Medicare beneficiaries is contrary to CPT® guidelines, which state, “Report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings.” To report anesthesia for a screening-turned-diagnostic colonoscopy, you’ll need to determine which set of rules your payer follows, in each circumstance.