New GI Codes

ataylor77

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There is some confusion in my office about what ASA to use with 45378. Are we supposed to use 00812 with 45378 ONLY if the diagnosis is Z12.11, and use 00811 with 45378 if the diagnosis is anything other than Z12.11?

Thank you,

Amanda Taylor, CPC
 

Davieda Skobel

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New GI codes

From the information I received at our last 2018 CPT updates the anesthesia codes for screening and diagnostic colonoscopies have been changed as you stated.
00811 is used for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified

00812 is used for Screening colonoscopy, regardless of the outcome or ultimate findings.

Basically if it started as a screening colonoscopy, even if they removed a polyp etc.,it stays a screening colonoscopy. as long as your 1st diagnosis is the Z12.11 you use the 00812.

A colonoscopy done for a reason or symptom is coded a 00811.

I always try to remember that a screening colonoscopy can only be done if there are NO signs or symptoms.
Physicians sometimes like to document "screening colonoscopy, rectal bleeding or diarrhea, or abdominal pain"etc. When they document that it no longer can be billed as a screening colonoscopy.

Also don't forget there is a new ASA for a combined upper and lower endoscopy....00813.

Hope this helps.
Davieda Skobel CPC, CLPN
 

bnanewbie

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New GI Codes/Modifiers

My first post to this site. There doesn't seem to be very much information relating to billing for the new codes. For example, some plans wanted a modifier 33 when the service was a screening. That seems redundant now that 00812, but there are no published articles. Has anyone viewed articles relating to this?

Thanks!

Bnanewbie.
 

jls4567

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Hi there,
Here is what I have found, https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3844CP.pdf
It does not mention to bill the 00812 with mod 33.
CPT instructs to bill the 00812 for a screening regardless of ultimate findings and CMS is instructing to bill a screening converted to a diagnostic exam as
00811 PT.
Notes on pages 17 and 40 of the above link:
"Anesthesia services furnished in conjunction with and in support of a screening
colonoscopy are reported with CPT code 00812 and coinsurance and deductible
are waived. When a screening colonoscopy becomes a diagnostic colonoscopy,
anesthesia services are reported with CPT code 00811 and with the PT modifier;
only the deductible is waived."


The problem I am having is with the new combination code-00813.
Does anyone have any guidance on how to code for when a patient has both an EGD and colonoscopy and the colonoscopy is done for a screening?


Any assistance/references would be appreciated.
Thank you,
Jeanna
 
Last edited:

LisaAlonso23

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[UPDATE]
We no longer append modifier PT to 00813


Per the Anesthesia Coders' Pink Sheet...

Switch to 00811 when service converts
"When the surgeon finds an issue such as a polyp or bleeding during a scheduled screening exam, it converts to a diagnostic service and you’ll report 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified) and modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure)."

Anesthesia for a screening colonoscopy will be reported with 00812. Modifier 33 is no longer needed, as 00812 is strictly for screenings.

Combined EGD & Screening Colonoscopy
"Providers should report the combined code 00813 (Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum), with modifier PT. Anesthesia practices will need to make certain that claim includes the appropriate ICD-10-CM Z code for the screening portion of the exam."

I hope this helps.
 
Last edited:

Nancy Klein

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Anesthesia for GI question/denial

Hello,
Upon reading the recent Anesthesia for GI posts am I correct with the following scenarios for MAC provided by an unsupervised CRNA?:
Screening colonoscopy: 00812 QZ/QS (no 33 needed)
Screening colon turned Diagnostic: 00811 QZ/PT/QS
 

dvorpagel

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CPT 45378 and ASA 00811

I am so confused!

I have a patient that had a colonoscopy for rectal bleeding. The procedure did not turn into anything therapeutic, it was not a screening, we have no op notes or further information. The patient has commercial insurance.\

I chose the codes:

45378 - ASA 00811

In the 2018 crosswalk CPT 45378 only crosses to 00812 or 00813

Which ASA do I use?
 

LisaAlonso23

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I am so confused!

I have a patient that had a colonoscopy for rectal bleeding. The procedure did not turn into anything therapeutic, it was not a screening, we have no op notes or further information. The patient has commercial insurance.\

I chose the codes:

45378 - ASA 00811

In the 2018 crosswalk CPT 45378 only crosses to 00812 or 00813

Which ASA do I use?
I double checked this, and you should use 00812. In the RVG, 45378 is also mentioned under 00812 stating this code should be used. They're really confusing the issue. I think we just need to code out & crosswalk the codes to be sure we're billing the correct codes. The articles I'm seeing are not helping much.

In the CPT manual, it appears they are using "screening" to also mean diagnostic which is wrong on so many levels. It states we should use 00812 for a screening of any kind.
 
Last edited:

aadair

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Hi there,
Here is what I have found, https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3844CP.pdf
It does not mention to bill the 00812 with mod 33.
CPT instructs to bill the 00812 for a screening regardless of ultimate findings and CMS is instructing to bill a screening converted to a diagnostic exam as
00811 PT.
Notes on pages 17 and 40 of the above link:
"Anesthesia services furnished in conjunction with and in support of a screening
colonoscopy are reported with CPT code 00812 and coinsurance and deductible
are waived. When a screening colonoscopy becomes a diagnostic colonoscopy,
anesthesia services are reported with CPT code 00811 and with the PT modifier;
only the deductible is waived."


The problem I am having is with the new combination code-00813.
Does anyone have any guidance on how to code for when a patient has both an EGD and colonoscopy and the colonoscopy is done for a screening?


Any assistance/references would be appreciated.
Thank you,
Jeanna

CMS is definitely instructing that if a screening colonoscopy turns diagnostic that you change your ASA code from 00812 to 00811 with a PT modifier. CMS has also made the decision to only pay 3 Base Units versus the 4 Base Units according to the RVG on "Screening Only" colonoscopies. It appears that CMS is "defining" the 00812 as a screening only code.

However, the CPT manual is telling coders something completely different regarding the 00812 code. The note (Report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings) totally contradicts what CMS is telling us to do. I, personally, feel that the way CMS is advising us to bill the Screening Only Colonoscopy as 00812 and the Screening turned Diagnostic as 00811 is the way all insurances should be coded. But, how will each insurance company interpret this discrepancy? This is yet to be seen.

Jeanna, regarding your question about using the 00813 code for an EGD and screening colonoscopy. Our anesthesia office thoroughly inquired with Medicare as to how to properly code a "combined" procedure. After numerous phone calls and inquiries, it was determined by Medicare that if a screening colonoscopy is being done in conjunction with an EGD, it is acceptable to bill for the screening to be paid according to the colonoscopy screening guidelines. Therefore, you bill the appropriate screening colonoscopy code and crosswalk it to the 00813 when an egd is being done at the same time. The RVG for the 00813 is 5 Base units. I do want to clarify that our inquiry with Medicare was done before these new GI ASA codes were created so we believe this is still correct information. We still plan to appropriately add the modifier 33 or PT to the 00813 and, again, it is yet to be seen how all the different insurances process these claims. We are hopeful the 33 or PT will identify that it was a combined screening/EGD and will pay as a screening. There are still too many unknowns to correctly utilize the new GI ASA codes.
 

LisaAlonso23

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CMS is definitely instructing that if a screening colonoscopy turns diagnostic that you change your ASA code from 00812 to 00811 with a PT modifier. CMS has also made the decision to only pay 3 Base Units versus the 4 Base Units according to the RVG on "Screening Only" colonoscopies. It appears that CMS is "defining" the 00812 as a screening only code.

However, the CPT manual is telling coders something completely different regarding the 00812 code. The note (Report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings) totally contradicts what CMS is telling us to do. I, personally, feel that the way CMS is advising us to bill the Screening Only Colonoscopy as 00812 and the Screening turned Diagnostic as 00811 is the way all insurances should be coded. But, how will each insurance company interpret this discrepancy? This is yet to be seen.

Jeanna, regarding your question about using the 00813 code for an EGD and screening colonoscopy. Our anesthesia office thoroughly inquired with Medicare as to how to properly code a "combined" procedure. After numerous phone calls and inquiries, it was determined by Medicare that if a screening colonoscopy is being done in conjunction with an EGD, it is acceptable to bill for the screening to be paid according to the colonoscopy screening guidelines. Therefore, you bill the appropriate screening colonoscopy code and crosswalk it to the 00813 when an egd is being done at the same time. The RVG for the 00813 is 5 Base units. I do want to clarify that our inquiry with Medicare was done before these new GI ASA codes were created so we believe this is still correct information. We still plan to appropriately add the modifier 33 or PT to the 00813 and, again, it is yet to be seen how all the different insurances process these claims. We are hopeful the 33 or PT will identify that it was a combined screening/EGD and will pay as a screening. There are still too many unknowns to correctly utilize the new GI ASA codes.

Thank you for the CMS information. It provides even more clarity.
 

awilson

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I think your coding is correct, as it never started as a screening.. remember the crosswalk is not always written in stone.. if your billing software won’t allow you to cross 45378 to 00811, will it let you enter only the 00811? That’s what i do sometimes when necessary. Haven’t had any denials, issues yet. All that goes on the claim usually is the asa code.

I am so confused!

I have a patient that had a colonoscopy for rectal bleeding. The procedure did not turn into anything therapeutic, it was not a screening, we have no op notes or further information. The patient has commercial insurance.\

I chose the codes:

45378 - ASA 00811

In the 2018 crosswalk CPT 45378 only crosses to 00812 or 00813

Which ASA do I use?
 

Deb P

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Trying 00813 With PT/33 Modifiers For Combo EGD/Screen-Screen to Dx Colos

Thank you, aadair, for your description. Our office is doing it this was as well & hoping for the best. When the article for this issue was posted in December, I questioned but there hasn't been a reply. (Two people asked me if there was a reply, so I linked them to this conversation. I hope you don't mind.) When I came across your description, I showed it to my supervisor who agreed we could try. I've asked our payment posters to let me know ASAP if we get any denials. I will reply to this post with our findings.


CMS is definitely instructing that if a screening colonoscopy turns diagnostic that you change your ASA code from 00812 to 00811 with a PT modifier. CMS has also made the decision to only pay 3 Base Units versus the 4 Base Units according to the RVG on "Screening Only" colonoscopies. It appears that CMS is "defining" the 00812 as a screening only code.

However, the CPT manual is telling coders something completely different regarding the 00812 code. The note (Report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings) totally contradicts what CMS is telling us to do. I, personally, feel that the way CMS is advising us to bill the Screening Only Colonoscopy as 00812 and the Screening turned Diagnostic as 00811 is the way all insurances should be coded. But, how will each insurance company interpret this discrepancy? This is yet to be seen.

Jeanna, regarding your question about using the 00813 code for an EGD and screening colonoscopy. Our anesthesia office thoroughly inquired with Medicare as to how to properly code a "combined" procedure. After numerous phone calls and inquiries, it was determined by Medicare that if a screening colonoscopy is being done in conjunction with an EGD, it is acceptable to bill for the screening to be paid according to the colonoscopy screening guidelines. Therefore, you bill the appropriate screening colonoscopy code and crosswalk it to the 00813 when an egd is being done at the same time. The RVG for the 00813 is 5 Base units. I do want to clarify that our inquiry with Medicare was done before these new GI ASA codes were created so we believe this is still correct information. We still plan to appropriately add the modifier 33 or PT to the 00813 and, again, it is yet to be seen how all the different insurances process these claims. We are hopeful the 33 or PT will identify that it was a combined screening/EGD and will pay as a screening. There are still too many unknowns to correctly utilize the new GI ASA codes.
 

EllieAnn

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EMBLEM Health has their own Policy

Be sure to check your commercial payers policy- if they have one . Emblem Health ( GHI/ HIP) has a policy now that states if there are findings they want that code first, then Z12.11 with 00812.

Ellie-Ann Marchese, CCS-P, CANPC

New reporting instructions for colon cancer screening anesthesia services and new 2018 CPT code updates to the EmblemHealth Preventive Care/Screening Services Exempt from Cost-Share

Date Issued: 1/12/2018

The Affordable Care Act (ACA) requires non-grandfathered health plans in the individual and group markets to cover certain preventive/screening care services received from in-network providers, in full, without member cost-sharing (i.e., without co-pay, deductible and/or co-insurance). In general, eligible services include preventive/screening care services which have received an “A” or “B” rating from the United States Preventive Services Task Force (USPSTF) or have been set forth in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA), as well as immunizations recommended by the Advisory Committee on Immunization Practices (ACIP). For additional information about these guidelines and recommendation, please click on the link(s) below:

http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/

http://bphc.hrsa.gov/policiesregulations/preventiveguide.html

http://www.cdc.gov/vaccines/acip/

Effective 0101/2018

Updated Instructions for Anesthesia for Colon Cancer Screenings to Providers for Coding Claims for ACA Mandated Preventive Care Services:

Preventive/Screening Colonoscopy
1.Services provided by the in-network endoscopist, anesthesiologist and pathologist associated with an in-network preventive/screening colonoscopy are eligible for coverage without member cost-sharing.
2.With the understanding that a preventive/screening colonoscopy may become diagnostic or therapeutic due to unforeseen findings, the AMA CPT Code that most accurately represents the procedure performed should be reported. The appropriate preventive/screening ICD diagnosis code (e.g., V76.51) should be entered into the first claim diagnosis field.
3.Anesthesia services should be reported with any specific findings entered into the first claim diagnosis field. The second claim diagnosis code should be reported with the appropriate preventive/screening ICD diagnosis code (e.g., Z12.11). CPT code 00812 MUST be used if the screening colonoscopy becomes a diagnostic colonoscopy and/or if the screening colonoscopy is stopped due to poor preparation and a sigmoidoscopy is done. While modifier 33 may be reported along with the anesthesia CPT code, it is not used in making preventive care benefit determinations; EmblemHealth considers the procedure and diagnosis codes when determining whether preventive care benefits apply. Pathology services should be reported with the appropriate screening ICD diagnosis code (e.g., Z12.11) entered into the first claim diagnosis field. Pathology services should be reported with the appropriate screening ICD diagnosis code (e.g., V76.51) entered into the first claim diagnosis field.

Additionally, the American Medical Association (AMA) has published coding changes effective 0101/2018. Please note the following additions and deletions to the Preventive Care Services Table:

Deleted CPT/HCPCS codes as of 12/31/2017:

Q2039 - Influenza virus vaccine, not otherwise specified

G0202 - Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

00810 - Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

New CPT/HCPCS codes effective 01/01/2018:

90756 - Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use

00812 - Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy

G0513 - Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)

G0514 - Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)

0500T - Infectious agent detection by nucleic acid (DNA or RNA), human papillomavirus (HPV) for five or more separately reported high-risk HPV types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) (ie, genotyping)

J7296 - Levonorgestrel-releasing intrauterine contraceptive system, (kyle
 
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ASA crosswalk update

There is some confusion in my office about what ASA to use with 45378. Are we supposed to use 00812 with 45378 ONLY if the diagnosis is Z12.11, and use 00811 with 45378 if the diagnosis is anything other than Z12.11?

Thank you,

Amanda Taylor, CPC
Hello,

That was an oversight by the ASA. Per a webinar by Devona Slater, the ASA issued an update, which states in part:

In this Timely Topic, we provide additional information specific to the 2018 CROSSWALK entries for procedure codes 45330 - Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) and 45378 - Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure).

The 2018 CROSSWALK entries for these procedures list code 00812 as the primary anesthesia code option and offer code 00813 as an alternative to be reported when the patient undergoes both an upper and lower GI endoscopy during the same anesthetic.

The ASA CROSSWALK Editorial Panel notes that in some instances, it may be appropriate to report anesthesia care for these procedures with code 00811, such as when a screening colonoscopy becomes a diagnostic colonoscopy. The Centers for Medicare & Medicaid
Services (CMS) has posted instructions that support this stance via MM10181 and R3844CR.
In general there is a lot of confusion about these codes. Hope this helps.
 

lconley

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Anesthesia new GI codes

I get the 00812 needing to be billed as 00811-PT when additional findings on a Medicare patient.
Does anyone have any guideline on commercial carriers? I know Cigna does not follow and must remain as 00812.
Any idea what Blue Cross' guidelines are?
 
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I get the 00812 needing to be billed as 00811-PT when additional findings on a Medicare patient.
Does anyone have any guideline on commercial carriers? I know Cigna does not follow and must remain as 00812.
Any idea what Blue Cross' guidelines are?
Unfortunately it is going to be a by-carrier issue. For example, someone recently told me about a Blue plan that wants 00812-33 for screenings and 00812 for cases that convert.
 

lconley

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screen colonoscopy with an EGD

I understand the combined code of 00813 but my question is related to the diagnosis. The colonoscopy is routine but the EGD is not. I was under the impression that the combined 00813 was never considered routine so using Z12.11 was incorrect. I'm getting conflicting information so am looking for a clarification. Can I bill 00813 with Z12.11 if that is how the surgeon billed the colonoscopy? Do I disregard the EGD finding?
 

LisaAlonso23

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I understand the combined code of 00813 but my question is related to the diagnosis. The colonoscopy is routine but the EGD is not. I was under the impression that the combined 00813 was never considered routine so using Z12.11 was incorrect. I'm getting conflicting information so am looking for a clarification. Can I bill 00813 with Z12.11 if that is how the surgeon billed the colonoscopy? Do I disregard the EGD finding?
If a patient had a colon screening (no other procedure) with an EGD, here’s how it would be coded:

45378/00813
Z12.11, colonoscopy finding, EGD diagnosis, supporting diagnosis
 
Last edited:
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gu
Per the Anesthesia Coders' Pink Sheet...

Switch to 00811 when service converts
"When the surgeon finds an issue such as a polyp or bleeding during a scheduled screening exam, it converts to a diagnostic service and you’ll report 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified) and modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure)."

Anesthesia for a screening colonoscopy will be reported with 00812. Modifier 33 is no longer needed, as 00812 is strictly for screenings.

Combined EGD & Screening Colonoscopy
"Providers should report the combined code 00813 (Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum), with modifier PT. Anesthesia practices will need to make certain that claim includes the appropriate ICD-10-CM Z code for the screening portion of the exam."

I hope this helps.
 

LisaAlonso23

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UPDATE IN 2019

For a screening colonoscopy only:
00812 (commercial insurance)
00812 (MCR & MCR Advantage Plans)

DX: Z12.11, finding, co-morbidity

For a screening colonoscopy with a procedure (ie, polypectomy, biopsy):
00812-PT (commercial insurance)
00811-PT (MCR & MCR Advantage Plans)

DX: Z12.11, finding, co-morbidity

For a screening colonoscopy (with or without a procedure) with an EGD:
00813 (commercial insurance)
00813 (MCR & MCR Advantage Plans)
PT is not appended to 00813

DX: Z12.11, colonoscopy finding, EGD finding, co-morbidity

For a colonoscopy due to a condition:
00811 (commercial insurance)
00811 (MCR & MCR Advantage Plans)
PT is not appended

DX: condition, co-morbidity

Adding a Co-morbidity
Being that anesthesia is not required for these procedures, we add a co-morbidity to justify the use of anesthesia.

If MAC is used, check the state's LCD for MAC to make sure a co-morbidity on the list is also coded.
 
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