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:
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; 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:

Anesthesia and Pain Management CANPC

John Verhovshek
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About Has 577 Posts

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering 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.

No 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’ .
    Saikrisna Chennoju CPC.

  3. jackie powell says:

    question – should we be adding 1 extra base unit for lateral position for colonoscopies since the code has change to 4 base units? if not medicare

  4. Amber Powell says:

    What if a patient has a screening colonoscopy and an EGD performed at the same time? The combo code 00813 seems to be appropriate but how do we signal to Medicare that the colonoscopy was a screening?

  5. Amber Powell says:

    What anesthesia CPT would be appropriate for when a patient presents for an EGD and screening colonoscopy?

  6. Deb says:

    What anesthesia CPT code would you use for a diagnostic colonoscopy and what level II modifier would you assign

  7. Deb says:

    What CPT code and level II modifier would you use for anesthesia on a Diagnostic Colonoscopy