Anesthesia Coding Alert

Hint: Your best starting point is confirming screening vs. diagnostic.

Endoscopic and GI (gastrointestinal) procedures are common enough, but that doesn’t mean your anesthesia coding is consistently the same. Having a clear understanding of the anesthesia options and taking time to keep up with payer policies will help you find coding success no matter the circumstances.

Starting point: CPT^® distinguishes the anesthesia codes for endoscopic GI procedures as “upper” or “lower.” Your options, which were updated by CPT^® in 2018, are:

• 00731 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified)
• 00732 (… 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). Relative Value Guide (RVG^®) comments remind coders to report 00813 when both upper and lower endoscopy are performed during the same session.

When to use them: You’ll probably turn to 00731 most often because it applies to EGD (esophagogastroduodenoscopy) and is the code most reported to Medicare, according to Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. Submit 00790 for gastric or laparoscopic gallbladder procedures to ensure your practice captures the additional base units allowed.

Make sure the documentation is clear enough to determine whether a screening colonoscopy (reported with 00812) becomes a diagnostic procedure. In that case, read the tips below to determine the best coding option.

Tips: According to CPT^®, anesthesia for a screening colonoscopy is reported with code 00812. However, when a screening colonoscopy becomes a diagnostic procedure, CMS requests that you report 00811 with modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Make sure you are aware of the specific payer policy for screening colonoscopies, which may affect whether a copay or deductible applies and how much your patient is required to pay.

Determine the Best Diagnosis

Check both the anesthesia record and the performing physician’s record to pinpoint the most accurate diagnosis for the encounter.

Important: Keep in mind that the diagnosis supporting anesthesia may be tied to a co-existing medical condition and not the gastrointestinal condition that led to the procedure. Diagnoses that could apply include but are not limited to:

• Parkinson’s disease (G20)
• Heart conditions (such as the codes from I21, ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, or I49.01, Ventricular fibrillation)
• Mental subnormality or retardation (F70-F79, ...Intellectual disabilities)
• Seizure disorders (such as R56.9, Unspecified convulsions)
• Anxiety (such as F41.1, Generalized anxiety disorder)
• Encounter for screening for malignant neoplasm of colon (Z12.11)
• Personal history of other malignant neoplasm of large intestine (Z85.038)
• Family history of malignant neoplasm of digestive organs (Z80.0)

“Specific diagnosis codes can really help justify anesthesia, particularly when it comes to screening colonoscopies,” Dennis says. “The challenge is to make certain that the documentation supports whether it is truly a screening colonoscopy.”

Watch for Payer Differences

Before getting too far with your claim, ensure you’re up-to-date on the payer’s guideline for MAC during endoscopic procedures. Although many of the MAC local coverage determinations (LCD’s) were removed, Novitas still publishes under LCD L35049, with coding information moved to Article A57361.

Why it matters: Payment policies for anesthesia services can differ from state to state or from payer to payer. A claim denied by one payer might be processed by another with no problems.

Start by searching for whether your major payers have policies posted online; if so, check them regularly. If the policies aren’t online, make a point to connect with payer reps on a regular basis (or once a year at minimum) to be sure you haven’t missed any important updates.

The time you spend confirming details now will pay off with easier claims processing later.

Focus on a Single Anesthesia Code (Usually)

It’s not uncommon for the gastroenterologist to complete more than one procedure during the encounter – but that doesn’t mean you report multiple anesthesia codes under all circumstances. Instead, report the anesthesia code that represents the most complex procedure from the encounter. Calculate the time units based on the combined (or total) time for all procedures the surgeon performs, but tie those units to a single anesthesia code with the highest base value.

Example 1: The physician completes an EGD and colonoscopy during a single encounter. Your anesthesiologist documents a combined start/end time of 60 minutes. Report 00813 with the total amount of time.