# anesthesia with colonoscopies



## katiejeanne (May 24, 2012)

Currently we are having CRNAs come in to do MAC anesthesia for our colonoscopies. According to the CPT book, moderate sedation is included in this range of codes. So our hospital is essentially paying for the CRNAs to come in and not charging anything extra for the patients than if the surgeon did the sedation himself. I just wanted to throw a question out there to you guys to see if any of you are somehow able to charge and get paid for any anesthesia services during colonoscopies. Does comorbidities affect this, or a special modifier? Or maybe no one else is getting paid for this either. Let me know any thoughts, thanks in advance!!

Katie, RHIT


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## Kisalyn (May 24, 2012)

I'm not going to be able to help, but just wanted to chime in that our physicians have started using anesthesia this year in the ASC. They have contracted with an outside company to handle billing and reimbursement. From what we have gathered so far is that Medicare and Medicaid are paying for it. They are not contracted with any of the commercial insurances yet, but are trying to get contracted so that when we take over the billing, everything will be in place for us.

Some insurances are not paying for this additional service at all citing that it is not medically necessary.

We are in Indiana, by the way.


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## aaron.lucas (May 29, 2012)

I would say yeah, you should be able to charge because you're using MAC, which is a different type of anesthesia service.  like you said, the moderate sedation is included, but you're not using that.  As far as modifiers, you would need to use I believe QZ, which is CRNA without direction.  if there is an anesthesiologist directing the nurse, then you would use QX.  Other than that you should be good to go.


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## TammyW (May 29, 2012)

hey Katie,   Moderate sedation is included if the surgeon is sedating or overseeing another specified person, such as an RN.   However, in your case, the surgeon is not overseeing the CRNA and more than moderate sedation is being administered.  CRNA's have their own provider numbers and can bill for their anesthesia services.   We bill .. and are paid.. for our colonoscopies.   Most are done using code 00810.   Comorbidities and anesthesia type (MAC, General) do come into play, as well as any history of failed moderate sedation.


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## katiejeanne (May 30, 2012)

I totally agree. MAC is more than moderate sedation and I think it should be coded also. Thanks for your input everyone!

Katie


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## pamsbill (May 31, 2012)

katiejeanne said:


> Currently we are having CRNAs come in to do MAC anesthesia for our colonoscopies. According to the CPT book, moderate sedation is included in this range of codes. So our hospital is essentially paying for the CRNAs to come in and not charging anything extra for the patients than if the surgeon did the sedation himself. I just wanted to throw a question out there to you guys to see if any of you are somehow able to charge and get paid for any anesthesia services during colonoscopies. Does comorbidities affect this, or a special modifier? Or maybe no one else is getting paid for this either. Let me know any thoughts, thanks in advance!!
> 
> Katie, RHIT



Yes, we bill for MAC delivered by both CRNA's and anesthesiologists for colonoscopies and EGD's.  You will need to check the CRNA scope of practice for your specific state for one thing because that differs from state to state. 

-PJM


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