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Thread: sedative for colonoscopy done in facility

  1. #1
    Join Date
    Apr 2007

    Default sedative for colonoscopy done in facility

    AAPC: Back to School
    Yesterday I rec one answer, but it was not satisfactory for the anesthesiologist at our facility. Hopefully someone can help me find the answer.
    We contract the anesthesiologist, they insist under the 2009 final payment changes for ASC, they are able to bill for a sedative called "Propofol" as this drug can only be administered by an anesthesiologist. Does anyone have any information regarding this?
    Thank you,

  2. #2
    Join Date
    Apr 2007
    Boardman, Ohio


    like i said in my email, the physician (anesthesiologist) cannot bill for the medications, that is part of the facility charge (ASC) Maybe im not understanding your question?

    We use propofol all the time for our groups and we have never billed for the actual medication (using HCPCS codes)

    please let me know what you come up with...i really do hope this helps
    Last edited by ohiocoder101; 08-05-2009 at 04:16 PM.
    Julie S., CPC
    Anesthesia Coder
    Education Officer, Cleveland Area Chapter 2016
    Email: medcoder05@gmail.com

  3. #3
    Join Date
    Apr 2007
    Pasadena, CA


    we use code 00810 for our anesthesiologists as we're billing for anesthesia services for colonoscopy & always get paid.

  4. #4


    Propofol is one of the medications on Medicare's MAC LCD that meets medical necessity for a physician to be billing MAC for certain CPT codes that generally do not require anesthesia. Look at Highmark Medicare LCD

  5. #5


    Forgive me for sounding potentially inexperienced, but, if you are just billing for the anesthesiolgist himself, why would you bill for the propofol? I always thought that the facility billed for it because they are the ones who buy the medications and its considered a "technical" componenent. Am I right in assuming that you are just billing the professional side of it?

  6. #6
    Join Date
    Apr 2007


    We went thru the same thing about two weeks ago. Our docs are going to start at a GI center and wanted to know about the reimbursement. We called Cigna and it is reimbursed only under Part A because it considered a supply. Of course they will get paid for performing the anesthesia but NOT for any drugs/supplies. Hope this helps!


  7. #7


    You cannot bill for the drug itself (ASC would), but the anesthesiologist or CRNA may charge for the anesthesia time only. Propofol is required to be administered by an anesthesiologist or CRNA (MD can only administer versed, Demerol, and Fentanyl). We are also a GI clinic who has several ASC's and we do most of our procedures with propofol. We bill CPT 00810 for anesthesia with Propofol. If Propofol/Pantethal is not used, anesthesia time cannot be billed. We get paid for these all the time and rarely get denials.

  8. #8

    Default propofol-endo/colo

    We are a ASC are we supposed to be billing for the propofol? And if so what codes are we using ? cpt/icd-9/mod?

    Thank you

  9. #9
    Join Date
    Apr 2007
    Green Bay, WI


    Per the HCPCS manual, J3490 is the correct code for Propofol 10mg administered IV.

    I have a different issue...if the facility/ASC is NOT billing for the Propofol & the anesthesiologist's office IS billing for it because THEY purchased & administered the drug...should the anesthesiologist get reimbursed for J3490 or would this be unbundled from his anesthesia service (CPT 00810)?

  10. #10


    we are a billing service for anesthesiologist and we were told they buy their propofol and that's why we bill for them, except the smaill facilities who provides them during procedure, so we do not bill in such cases. And also we were asked not to bill Medicare and medicaid patient for propofol.

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