Wiki Anesthesia Colonoscopies/EGDs

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Melissa*Ever*Evolving

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Yes, Unfortunately, I am bringing this topic up again.
I have been receiving denials for modifier combinations with:
00812-AA-PT
00813-AA-PT-QS

After much deliberation, we had changed claim 00812-AA-PT to 00811-AA-PT. (This began as screen and turned diagnostic)
Based on many references stating Medicare would not follow the AMA instruction of "once a screen, always a screen."

On the 00813-AA-PT-QS, my team and I decided that it is possible that CMS will not consider the colonoscopy preventive benefit since there were symptoms presented to also perform the EGD. (However, The colonoscopy portion was a screening.) We dropped off the PT in this mindset.

Now today, I have discovered an update to the NCD 210.3 posted by MLN Matters article MM10473 Released 2/16/18.
Please see the attachment for the information being released to our MACs to adjust their Processing!

I am so confused.
Why can't CMS publish something to cover all cicumstances regarding colonoscopies and the new Anesthesia codes and stick to it?:mad:

Does anyone have an awesome tool to help with this for MEDICARE claims? I understand commercial carriers vary.

Thank you so much in advance!
~Melissa, CPC
 

Attachments

  • MLN Matters NCD Updates.pdf
    444.5 KB · Views: 47
If the attachment continues to not load, please search
MLN Matters Number: MM10473
Related CR Release Date: 2/16/18
Effective Date: 7/1/18
Implementation Date: 4/2/18 for local MAC

page #2 discusses NCD210.3 Colorectal Cancer Screening
The official instruction, CR10473, issued to your MAC regarding this change is available at
https://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/2018Downloads/R2033OTN.pdf.

See bottom of page 4. number 10473.7

"NCD210.3 Colorectal Cancer Screening
Contractors shall end-date CPT 00810, effective 12/31/17.
Contractors shall add CPT 00812, effective 1/1/18, modifier -33 continues to apply.
Removed all ICD-9 codes in spreadsheet.
See spreadsheet."

Another link on this takes you to the Rules Description:
"B/MACs: For colorectal cancer screening, effective 1/1/18, when anesthesia 00812 is performed in conjunction with screenign colonoscopy G0105 or G0121, coinsurance and deductible will be waived for anesthesia 00812 when modifier- 33 is entered on anesthesia claim.
When screening colonoscopy becomes dx colonoscopy, anesthesia 00812 should be submitted with only -PT modifier and only deductible will be waived"

~Melissa
 
Hi,

I contacted Medicare about that and they confirmed that the NCD release was an error. You should report 00811-PT with screening colonoscopies that convert to diagnostic. You do not need modifier 33 with 00812. (For Medicare and most private payers I've seen).
 
Anesthesia tool

StardustCoder said:
Does anyone have an awesome tool to help with this for MEDICARE claims? I understand commercial carriers vary.

Thank you so much in advance!
~Melissa, CPC
Click to expand...

Hi, I created a decision tree for Medicare rules that might help. If you want to email me: jkyles [at] decisionhealth [dot] com I can send it along.

Julia Kyles, CPC
 
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