Revenue Cycle Insider

Question: When coding anesthesia services for endoscopic gastrointestinal procedures, what’s the delineation between upper and lower?

Vermont Subscriber

Answer:

CPT^® defines the upper and lower gastrointestinal tract based on anatomical divisions.

The upper gastrointestinal tract typically includes the structures from the mouth to the duodenum, which is the first part of the small intestine. This includes the esophagus, stomach, and duodenum.

The lower gastrointestinal tract typically includes the structures from the jejunum, which is the second part of the small intestine, to the anus. This includes the jejunum, ileum, colon, rectum, and anus.

When it comes to endoscopic procedures, CPT^® codes often specify whether the endoscope was introduced proximal to (before) or distal to (after) the duodenum. This helps to distinguish between upper and lower gastrointestinal procedures.

One can report the anesthesia services for endoscopic gastrointestinal procedures with these CPT^® codes:

• 00731 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified)
• 00732 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP))
• 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified)
• 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified)
• 00812 (… screening colonoscopy)
• 00813 (Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum).

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC