Anesthesia Coding Alert

Question: There is some confusion in our office about which anesthesia code we should use in conjunction with 45378. Are we supposed to report 00812 with 45378 only if the diagnosis is Z12.11, and use 00811 if the diagnosis is something else?

Illinois Subscriber

Answer: According to the current CPT^® guidelines, the primary anesthesia crosswalk for 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) is 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy), which has a base value of 4. You should submit 00812 to report anesthesia during a screening colonoscopy, regardless of the outcome or ultimate findings.

Rule of thumb: A screening colonoscopy refers to a test that is performed if the patient does not have any signs or symptoms signifying a potential issue. A colonoscopy that is performed for a reason or symptom is coded as 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified).

If the physician’s primary diagnosis is Z12.11 (Encounter for screening for malignant neoplasm of colon), you should report 00812 for anesthesia services.

Also good to know: CPT^® 2018 introduced a new code for anesthesia during a combined upper and lower endoscopy: 00813 (Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum). The ASA Crosswalk lists 00813 as an alternative to consider when you have clear documentation of both portions of the service. Traditional Medicare does not follow CPT^® guidance, so make sure you follow CMS guidance when applicable.