Anesthesia Coding Alert

Question: Can a CRNA bill Medicare for anesthesia during a colonoscopy? If so, what requirements are we expected to meet?

South Carolina Subscriber

Answer: Yes, a certified registered nurse anesthetist (CRNA) can bill Medicare for diagnostic colonoscopy services, although it would be wise to check with the payer in question prior to the procedure. If you file a claim, the correct code and modifier will depend on the type of sedation administered.

For general anesthesia or monitored anesthesia care (MAC), report 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified). Reporting MAC is appropriate if the payer recognizes that anesthesia service is medically necessary for the procedure or if you plan to bill the patient. If you are billing the patient, they should sign a waiver prior to the procedure accepting payment responsibility.

For moderate sedation, choose from 99155 (Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age), 99156 (… initial 15 minutes of intraservice time, patient age 5 years or older), and +99157 (... each additional 15 minutes intraservice time (List separately in addition to code for primary service)) as needed. Your choice will be based on the patient’s age and the length of the procedure.

Some payers require that you also include moderate sedation modifiers with these claims. When that’s the case, look at appending modifier QS (Monitored anesthesia care service), G8 (Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure), or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition).

If a Medicare patient signed a waiver of liability, modifier GA (Waiver of liability statement issued as required by payer policy, individual case) indicates than an advanced beneficiary notice (ABN) is signed and on file.