Anesthesia Coding Alert

Question: A new Medicare patient was scheduled for a routine screening colonoscopy after the family physician learned the patient’s mother had passed away from colon cancer. Our physician provided monitored anesthesia; the gastroenterologist removed several polyps during the procedure. How should we code this?

Kentucky Subscriber

Answer: Begin with anesthesia code 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum). Then append modifier PT (A colorectal cancer screening test which led to a diagnostic procedure) since the encounter shifted from a routine screening colonoscopy to a therapeutic procedure when the surgeon detected and removed polyps. The addition of modifier PT results in the waiver of the deductible, if applicable, and the patient is responsible for the coinsurance.

Remember: According to the 2015 Physician Fee Schedule final rule, the new definition of colorectal cancer screening tests that includes anesthesia as a separately payable service with screening colonoscopies is a national policy, which takes precedence over any local coverage policy. When a screening colonoscopy is converted to a diagnostic or therapeutic colon procedure, however, all Medicare medical necessity guidelines apply.