Anesthesia Coding Alert

Question: We submitted both 00740 and 00810 for anesthesia during a procedure, but the insurance paid only one code. Could you explain why?

Oregon Subscriber

Answer: When two (or more) procedures are done at the same time, only the anesthesia code with the higher base unit value is reported.

In the case you describe, 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) both have a base unit value of 3, so you should bill the one that has the best supporting diagnosis. Include the total amount of anesthesia time for both procedures with that single anesthesia code. If in doubt of which code to submit, ask for a copy of the surgeon’s report or speak to a coder in the surgeon’s office for verification of which code might be more appropriate. When your anesthesia options are so similar and have the same number of base units, either code should pass muster with the payer.

Reminder: If you’re coding for a screening colonoscopy, don’t forget to include a modifier to describe whether the deductible and copay are waived. If both are waived, append modifier 33 (Preventive services). If only the deductible is waived, append HCPCS modifier PT (Colorectal cancer screening test, converted to diagnostic test or other procedure).