Anesthesia Coding Alert

Reader Question:

Payer Dictates Propofol With Endoscopic Procedures

Published on Mon Jul 09, 2012

Question: Is Propofol separately reimbursable with endoscopic procedures, or is it bundled into the procedure charge? Does this vary between Medicare and commercial insurances?

Mississippi Subscriber

Answer: Anesthesiologists normally bill professional fees and the facility bills for any medications. Correct Coding Initiative (CCI) edits don't bundle the procedure and medication, but the Propofol is classified as "Status code E: Excluded from Physician Fee Schedule by regulation." Payers that follow CCI probably won't pay separately for the Propofol, but you can check with each of your insurers to learn whether their stance varies.

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