Anesthesia Coding Alert

Question: What code should I be using for anesthesia during an acid check?

Cheryl Pascale, Hackensack Anesthesiologists, Hackensack, N.J.

Answer: The most appropriate code will vary, depending on exactly what is being done. These procedure codes could apply: 91010 (esophageal motility [manometric study of the esophagus and/or gastroesophageal junction] study), 91011 (esophageal motility study; with mecholyl or similar stimulant), 91012 (esophageal motility study; with acid perfusion studies), 91030 (esophagus, acid perfusion [Bernstein] test for esophagitis), 91032 (esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux) or 91033 (esophagus, acid reflux test, with intraluminal pH electrode for detection of gastroesophageal reflux; prolonged recording).

When an esophageal manometry is reported with an acid perfusion test, the services should be processed under code 91012. If the tests are reported as separate procedures (e.g., 91030 and 91010-91011), the charges should be combined. Esophagogastric manometric studies should be processed under code 91020.
When you check the ASAs 2000 Crosswalk, all of these procedures crosswalk to anesthesia code 00740 (anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum), which is charged at 5 units plus time. Many Medicare carriers have policies concerning payment for 00740. Some local carriers will pay all these claims, others (such as Texas) place them in a policy, and others will pay only after their definition of medical necessity has been met. Reimbursement for 00740 is very regionally dependent. It is best to check with your local carrier on its policy.