Gastroenterology Coding Alert

Question: I heard that Aetna is discontinuing payment for propofol for endoscopies. Is this true? Could you explain more?

Georgia Subscriber

Answer: Aetna has decided to delay its plan to discontinue payment for anesthesiologists administering propofol for conscious sedation during routine endoscopic procedures. Humana and WellPoint no longer pay for propofol for most upper and lower endoscopies. They consider moderate sedation/analgesia provided by the endoscopist enough for average-risk patients.

However, Humana and WellPoint list exceptions to this rule, including patients over age 65, pregnant patients, patients who are morbidly obese, and more.