Anesthesia Coding Alert

Remember: the dx you report may not be related to the GI condition.

While some physicians rely on conscious sedation for endoscopies and colonoscopies, others may require the patient to be under general anesthesia for the procedure. When this is the case, you’ll need to know which of the anesthesia codes for gastrointestinal (GI) procedures you should document.

The codes themselves are relatively easy to understand. Even so, applying them often raises numerous questions. Here are some of the most frequently asked, along with the answers you need to precisely code for general anesthesia when required for a patient undergoing an GI endoscopy.

What Are the Anesthesia Codes for Endoscopic GI Procedures?

CPT^® distinguishes the anesthesia codes for endoscopic GI procedures as “upper” or “lower,” with the duodenum being the focus of the definition: upper GI procedures are “proximal,” or closer to the duodenum, while lower GI procedures are “distal,” or further away from the duodenum.

This gives you the following choices:

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

The difference between the codes is straightforward: “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,” according to CPT® Assistant, December 2017 (Volume 27, Issue 12).

What Happens if the Gastroenterologist Performs Multiple Procedures?

It’s not uncommon for the gastroenterologist to complete more than one procedure during the encounter — but that doesn’t mean you report multiple anesthesia codes under all circumstances. Instead, you should report the anesthesia code that represents the most complex procedure from the encounter. You should then calculate time units based on the combined (or total) time for all procedures the surgeon performs, but tie those units to a single anesthesia code with the highest base value.

Example: The physician completes an esophagogastroduodenoscopy (EGD) and colonoscopy during a single encounter. Your anesthesiologist documents a combined start/end time of 44 minutes. In this case, you would report 00813 with the total amount of time.

What Codes Do You Use When a Screening Colonoscopy Turns Diagnostic?

A colonoscopy is considered a screening when the patient is asymptomatic of polyps or colorectal cancer, whether or not the patient has previously had the condition. If the patient exhibits symptoms that commonly indicate colorectal cancer, such as abdominal pain and bleeding in the stool, provider documentation should indicate the need for a diagnostic colonoscopy to determine the cause of the symptoms.

According to CPT^®, you should report anesthesia for a screening colonoscopy with 00812. However, when a screening colonoscopy becomes a diagnostic procedure, the Centers for Medicare & Medicaid Services (CMS) requests that you report 00811 with modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure). Make sure you are aware of the specific payer policy for screening colonoscopies, which may affect whether a copay or deductible applies and how much your patient is required to pay.

What Diagnosis Codes Do You Use for Endoscopic GI Anesthesia?

You should check both the anesthesia record and the performing physician’s record to pinpoint the most accurate diagnosis for the encounter. While this will most often be tied to the gastrointestinal condition that led to the procedure, sometimes a co-existing medical condition may provide medical necessity for the use of anesthesia accompanying a GI endoscopy.

The most obvious code to choose for asymptomatic patients undergoing a screening would be Z12.11 (Encounter for screening for malignant neoplasm of colon) or a personal or family cancer history code, such as Z85.038 (Personal history of other malignant neoplasm of large intestine) or Z80.0 (Family history of malignant neoplasm of digestive organs). However, “payers may require Z12.11 to be reported as the primary code,” according to Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.

For symptomatic patients undergoing a diagnostic GI endoscopy, you might use a sign or symptom code, such as R19.5 (Other fecal abnormalities), which includes such conditions as abnormal stool color and occult blood in feces or in stools, or a code from R10.0- (Pain localized to upper abdomen), R10.3.- (Pain localized to other parts of lower abdomen), or R10.8- (Other abdominal pain).

But you might also code other, unrelated conditions that may require the patient to be put under full sedation for the duration of the procedure in order for the provider to conduct the procedure successfully. They could include such conditions as anxiety, coded to F41.- (Other anxiety disorders); intellectual disabilities, coded to F70-F79 (Intellectual disabilities); heart conditions, such as I21.- (Acute myocardial infarction) or I49.- (Other cardiac arrhythmias); convulsions, coded to R56.9 (Unspecified convulsions); or G20.- (Parkinson’s disease).