Anesthesia Coding Alert

Don’t forget to factor in the MAC possibility.

Coding for anesthesia during gastrointestinal endoscopic procedures became more complicated in 2018, when CPT^® introduced several new code options to consider. Read on for your refresher on the codes as well as real-world advice on successful reporting.

Starting point: You’ll choose from amongst five codes when your anesthesia provider is involved with these cases:

• 00731 – Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified
• 00732 – Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)
• 00811 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
• 00812 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy
• 00813 – Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum.

The 2018 code set added00731and00732to replace former code 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum). Codes 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified) and 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) also were deleted in the 2018 change.

According to the AMA in information published before the code changes went into effect, “Codes 00731 and 00732 should be reported for anesthesia for upper GI endoscopic procedures; 00811 and 00812 for anesthesia for lower intestinal endoscopic procedures; and 00813 for anesthesia provided for combined upper and lower GI endoscopic procedures” (Dec. 2017 edition of CPT^® Assistant).

Dig Deeper to Support Medical Necessity

Payers look for diagnoses that justify administering anesthesia during EGDs or other gastro procedures, says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. Your claim should include a diagnosis that indicates a co-existing medical condition that supports the anesthesiologist’s involvement, not just the gastrointestinal condition leading to the procedure.

Potential diagnoses could include:

• Parkinson’s disease (G20)
• Heart conditions (such as I21, Acute myocardial infarction or I49.01, Ventricular fibrillation)
• Seizure disorders (such as R56.9, Unspecified convulsions)
• Anxiety (such as F40, Phobic anxiety disorders or F41, Other anxiety disorders).

You might also be able to submit a diagnosis for failed sedation attempts: T88.52XA (Failed moderate sedation during procedure, initial encounter) or Z92.83 (Personal history of failed moderate sedation).

Pay Attention to Special Situations

No two procedures are ever exactly alike, even something as commonplace as an endoscopic GI. That’s why being aware of nuances during the procedure can help keep your coding on the right track.

Example 1: The physician often repositions the patient during the procedure when performing both upper and lower GI endoscopies during the same encounter. However, AMA guidelines do not allow you to collect extra payment for the adjustment. You simply report code 00813.

Explanation: “Additional anesthesia work, such as repositioning the patient, responding to physiologic changes when reinserting the scope into a different location, and other nonduplicative work involved in the additional procedure, is included in the combined upper and lower endoscopic code 00813,” CPT^® Assistant states.

Example 2: If a screening colonoscopy becomes diagnostic or therapeutic, (i.e., something abnormal is found and possibly treated/removed), the correct code will depend on the specific situation and the payer in question. CMS requires you to report 00811 if a screening colonoscopy becomes diagnostic and the physician finds something such as polyps; you should also append modifier PT (Colorectal cancer screening test converted to diagnostic test or other procedure). You’ll submit 00812 on CMS claims when a screening colonoscopy has no findings.

Non-CMS payers might follow the CPT^® guidelines stating that the 00812 code should be reported for a screening colonoscopy, irrespective of findings. “If the exam is performed for diagnostic reasons, including positive fecal occult blood, the 00811 code is reported, even if nothing abnormal is found,” says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a gastroenterologist in Pasadena, Cal.

Let Anesthesia Administration Guide You

Some physicians rely on conscious sedation for upper endoscopies and colonoscopies. If that’s the case in your practice, you might not have many situations that call for 00731 or 00732.

Modify it: When coding for MAC, remember to include MAC modifiers as needed. For Medicare patients, append modifier QS (Monitored anesthesia care service) to the procedure code. You might also need to report modifier G8 (Monitored anesthesia care for deep complex, complicated or markedly invasive surgical procedure) or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition), depending on the patient’s medical history.

Also remember: Different payers might have different guidelines for MAC during endoscopic procedures: a claim denied by one insurer might be paid by another. So, do your homework before filing claims. Taking the time to contact each insurer to verify their billing and reimbursement guidelines can pay off in the end with easier claims processing.