Anesthesia Coding Alert

Question: Our physician administered anesthesia for a patient who had a screening colonoscopy during the same session as an EGD for abdominal pain. We billed the patient’s insurance with 00740 and diagnosis R10.9. The insurer processed the claim and left the patient with a co-pay/deductible. He called complaining that his account was coded wrong and we should have billed the screening colonoscopy so that his insurance will cover at 100%. Isn’t that insurance fraud? He claims to be a coder for this insurance company and is demanding that we “just change it.”

I have been trying to find clear documentation that we coded this correctly (the facility and the surgeon’s office each billed only the colonoscopy so their claims were paid 100% by insurance). From our end, it seems we did everything correctly. But was there anything else we should have done?

Missouri Subscriber

Answer: Because anesthesia coders can only report one code for an operative session (no matter how many procedures might take place), your first step is to look at the codes and base units for both procedures: 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) and 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum). You would normally report the code with the higher number of base units, but these both have a base unit value of five.

Check your documentation to see if you’re justified in reporting 00810 instead of 00740. Add all the time units for both procedures to submit on the claim. File the screening colonoscopy as the primary diagnosis (Z12.11, Encounter for screening for malignant neoplasm of colon) and the R10.9 (Unspecified abdominal pain) as the secondary diagnosis.

You might also consider calling the payer and asking for guidance on how they want you to handle routine and non-routine procedures on the same date of service since you cannot report two anesthesia codes.