Reporting Anesthesia for Colonoscopy

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:

Anesthesia and Pain Management CANPC

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.

Resource

CMS, MLN Matters, MM10181: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10181.pdf

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

About Has 514 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.

2 Responses to “Reporting Anesthesia for Colonoscopy”

  1. Elizabeth says:

    This isn’t the moderate sedation, correct?

  2. Saikrisna Chennoju CPC. says:

    Yes, This is regarding coding of MAC (Monitored Anesthesia Care ) these 00812, 00811 are new CPT codes for previous codes ‘00810’ .

    Regards,
    Saikrisna Chennoju CPC.

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