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Colonoscopy w/propofol

  1. Question Colonoscopy w/propofol
    Medical Coding Books
    We are an ASC and have an anesthesiologist group do propofol with some procedures and they do their own billing. My question is, if propofol is used then the drugs for the moderate sedation is not used correct? And if this is correct then should there be a modifier or some type of code billed along with say CPT code 45380 to indicate that the moderate sedation was not used? Would we not receive a lower reimbursement as the moderate sedation is part of the global?
    I am not sure if we provide the propofol or if the anesthesiologist brings it, either way could someone please advise me on the proper billing for this?

  2. #2
    You should never bill the moderate sedation codes with colonoscopies or EGD's. In the CPT book the icon beside the code that looks like a bullseye means moderate sedation is included and should not be billed separately.

  3. #3
    The anesthesiologist would bill the anesthesia service as MAC (monitored anesthesia care) with the appropriate anesthesia code and modifiers.

    The materials, supplies and equipment for anesthesia services are included in the facility payment.

    Moderate sedation codes would apply to health care providers who are not anesthesiologists.


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