00811 00812 for Medicare Colonoscopy Anesthesia Coding

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.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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About Has 535 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

7 Responses to “00811 00812 for Medicare Colonoscopy Anesthesia Coding”

  1. Anna seidl says:

    Can you email this to me?

  2. Debbie Haney says:

    We paid for a webinar in December 2017 sponsored by ASGE which states to code 00812 for screening colons regardless of ultimate findings. You are stating to flip the code to 00811 for lower GI anesthesia with PT modifier to waive deductible when colon becomes diagnostic such as a polypectomy. It appears there is conflicting guidance on how to bill these new anesthesia codes accurately. Any thoughts?

  3. Tya Kent, CPC says:

    So are we still using the 33 modifier with the 00812? I noticed the article references the PT modifier for the 00811 but no mention of the 33 modifier at all.

  4. Eva Gillespie says:

    The 33 modifiers are no longer required. You will only use the PT modifier and that is on screening colonoscopy with findings.

  5. Sophia Dixon says:

    I’m curious what are you using for dx codes as Z12.11 is not covered nor are the polyp codes.

  6. April McClaughry says:

    I talked to Medicare and they said that the Z12.11’s are denying in error and they will be doing a mass reprocessing of all claims denied in error due to this issue. From my understanding the Z12.11 is the only DX code we can use to indicate that a screening was performed. Now saying that, sometimes when we call Medicare some reps don’t know about this “incorrect denial” situation so it is very frustrating to figure out how to get these paid. Also plans that follow Medicare guidelines are starting to deny any claims with the Z12.11 stating that they are not an approved Medicare LCD. Anyone else finding this issue and any successful outcomes or tips that you can share?

  7. Terri Moore says:

    I am fighting back and forth on how to use modifier and what modifier to use on just any colonoscopy and egd. Everything seems to be kicking out of my system. Any idea on how to bill the modifier with anything other than just a screening?

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