Reporting Anesthesia for Colonoscopy
The 2018 CPT® code book introduces two new codes to report anesthesia during colonoscopy, one of which is applicable specifically for a screening exam. But if a screening colonoscopy reveals diagnostic findings, proper coding for the anesthesia service may differ, depending on the payer.
CPT® Sticks with Screening Code 00812,
Regardless of Findings
CPT® 2018 deletes 00810 and introduces two new codes in its place:
00811 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
00812 screening colonoscopy
A parenthetical note follows the descriptor for 00812, “Report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings.”
In other words, if an exam begins as a screening, but the colonoscopy reveals a polyp(s) or other diagnostic finding, report the anesthesia service as a screening.
For Medicare, Findings
Result in Anesthesia Code 00811 with a Modifier
For a Medicare patient, 00812 remains appropriate for reporting the anesthesia services provided during a screening colonoscopy only if the patient is found to be asymptomatic. If there are diagnostic findings during the exam, coding for the anesthesia services no longer follows CPT® guidelines.
Per MLN Matters® 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.”
Medicare waives the patient’s deductible and coinsurance for screening colonoscopy reported using 00812; and waives the patient’s deductible for a diagnostic colonoscopy reported using 00811 with modifier PT Colorectal cancer screening test screening test, converted to diagnostic test or other procedure.
What’s the Takeaway?
To report anesthesia for a screening-turned-diagnostic colonoscopy, determine which set of rules your payer follows (CPT®, Medicare, or local), in each circumstance.
CMS, MLN Matters, MM10181: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10181.pdf