Wiki Anesthesia for GI Endoscopy new codes

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Anes for GI Endoscopy codes

Well, the Final Rule isn't out yet, the following is in the Proposed Rule, though!

Deleted: 00740 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum
New 007X1 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified (5 base units)
New 007X2 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP) (6 Base Units)


Deleted 00810 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum
New 008X1 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified (4 Base Units)
New 008X2 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy (4 Base Units)
New 008X3 Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum (5 Base Units)

L J
 
When to utilize 00811 and 00812

Hey All -

Just wondering if anyone can give some insight into how they are going to utilize these codes when a screening turns diagnostic. I now Medicare has stated to use anesthesia code 00811-PT when the patient starts as a screening and the procedure turns diagnostic, but for all other insurers unless specified is everyone using 00812 (per CPT guidelines)?

Also if the patient has both an EGD and a Colonoscopy and the colonoscopy is a screening would you use 00813-33?

Thanks!
 
RE: Concerns for patient's responsibility with new ASA codes

I have attached pdf file memo from CMS.

Medicare carrier:
screening colonoscopy ASA Code 00812 w/ no modifiers will waive both deductible and coinsurance
screening colonoscopy turns diagnostic/therapeutic ASA Code 00811 w/ pt will waive deductible
screening colonoscopy along with upper endo same anesthesia session ASA Code 00813; claims denied with both modifiers 33 and modifiers PT; invalid modifier procedure combination

We corrected a few claims with 00813 removing modifiers and they processed paid with patient coinsurance responsibility. However, we cannot find in writing that there will be patient coinsurance responsiblity....

We have been trying to get answers also, no written specifics about 00813 from CMS.

So far we know the Blueshield/Bluecross are taking both 33 and PT modifiers for ASA 00813.

If anyone have any information, much appreciated.
 

Attachments

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RE: Concerns for patient's responsibility with new ASA codes

We are having difficulty getting the new codes, 00811 and 00813 to process without medically necessary DX codes due to the LCD. Has anyone else had this issue?
 
2018 Anesthesia codes 00812/screening

I am hoping someone can answer this. I'm new to Anesthesia coding. When billing out for a screening colonoscopy that is just a screening, for our CRNA, do we bill that as 00812-QZ-P2 (example of patient status)-33? I'm trying to understand if I am supposed to be using all three modifiers for this or not. It's so confusing. Any help would be greatly appreciated. Thank you.
 
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rondakay2 said:
I am hoping someone can answer this. I'm new to Anesthesia coding. When billing out for a screening colonoscopy that is just a screening, for our CRNA, do we bill that as 00812-QZ-P2 (example of patient status)-33? I'm trying to understand if I am supposed to be using all three modifiers for this or not. It's so confusing. Any help would be greatly appreciated. Thank you.
Click to expand...

Unfortunately, use of modifier 33 will depend on the carrier. I can say that of the policies I reviewed earlier this year, most carriers don't want 33 because the code is specifically for a screening service. But not all.
 
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