# Anesthesia Colonoscopies/EGDs



## Melissa*Ever*Evolving (Feb 22, 2018)

Yes, Unfortunately, I am bringing this topic up again.
I have been receiving denials for modifier combinations with:
00812-AA-PT
00813-AA-PT-QS

After much deliberation, we had changed claim 00812-AA-PT to 00811-AA-PT. (This began as screen and turned diagnostic)
Based on many references stating Medicare would not follow the AMA instruction of "once a screen, always a screen."

On the 00813-AA-PT-QS, my team and I decided that it is possible that CMS will not consider the colonoscopy preventive benefit since there were symptoms presented to also perform the EGD. (However, The colonoscopy portion was a screening.) We dropped off the PT in this mindset. 

Now today, I have discovered an update to the NCD 210.3 posted by MLN Matters article MM10473 Released 2/16/18.
Please see the attachment for the information being released to our MACs to adjust their Processing!

I am so confused.  
Why can't CMS publish something to cover all cicumstances regarding colonoscopies and the new Anesthesia codes and stick to it?

Does anyone have an awesome tool to help with this for MEDICARE claims? I understand commercial carriers vary.

Thank you so much in advance!
~Melissa, CPC


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## Melissa*Ever*Evolving (Feb 23, 2018)

Has anyone looked at my attachment?

CMS is stating to add -33 to 00812.

This NCD change announcement came from WPS GHA.


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## awilson (Feb 24, 2018)

I don’t see an attachment


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## Melissa*Ever*Evolving (Feb 26, 2018)

Please let me know if this doesn't work.
Applied attachment again.
~Melissa


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## Melissa*Ever*Evolving (Feb 26, 2018)

If the attachment continues to not load, please search
MLN Matters Number: MM10473
Related CR Release Date: 2/16/18
Effective Date: 7/1/18
Implementation Date: 4/2/18 for local MAC

page #2 discusses NCD210.3 Colorectal Cancer Screening
The official instruction, CR10473, issued to your MAC regarding this change is available at
https://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/2018Downloads/R2033OTN.pdf.

See bottom of page 4. number 10473.7

"NCD210.3 Colorectal Cancer Screening
Contractors shall end-date CPT 00810, effective 12/31/17.
Contractors shall add CPT 00812, effective 1/1/18, modifier -33 continues to apply.
Removed all ICD-9 codes in spreadsheet.
See spreadsheet."

Another link on this takes you to the Rules Description:
"B/MACs:  For colorectal cancer screening, effective 1/1/18, when anesthesia 00812 is performed in conjunction with screenign colonoscopy G0105 or G0121, coinsurance and deductible will be waived for anesthesia 00812 when modifier- 33 is entered on anesthesia claim. 
When screening colonoscopy becomes dx colonoscopy, anesthesia 00812 should be submitted with only -PT modifier and only deductible will be waived"

~Melissa


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## jkyles@decisionhealth.com (Mar 2, 2018)

Hi, 

I contacted Medicare about that and they confirmed that the NCD release was an error. You _should_ report 00811-PT with screening colonoscopies that convert to diagnostic. You do not need modifier 33 with 00812. (For Medicare and most private payers I've seen).


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## jkyles@decisionhealth.com (Mar 2, 2018)

*Anesthesia tool*



StardustCoder said:


> Does anyone have an awesome tool to help with this for MEDICARE claims? I understand commercial carriers vary.
> 
> Thank you so much in advance!
> ~Melissa, CPC



Hi, I created a decision tree for Medicare rules that might help. If you want to email me: jkyles [at] decisionhealth [dot] com I can send it along. 

Julia Kyles, CPC


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