Anesthesia Coding Alert

Question: Should I include any modifiers when submitting claims for a double procedure, such as an upper and lower endoscopy performed during the same session?

Wisconsin Subscriber

Answer: When your physician provides anesthesia instead of performing the procedure, you should only report one code for his service (with the exception of a few services such as Swan-Ganz line placement, 93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes). Choose the procedure with the highest-base anesthesia value, and then submit that code with the total amount of time your physician spent on all procedures during that session.

The two anesthesia codes that apply to your case are 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). Each of these codes has five base units, so you can report either choice and be within correct guidelines.

Remember: Anesthesia codes are based on anatomic area -- and you only receive reimbursement for the highest initial procedure for one of them, so you only need to code for the highest-based procedure. Coding first for the highest-based procedure is always key (along with matching the reported diagnosis with the anesthesia code). Coding for a lower-based procedure can reduce your reimbursement.