Anesthesia Coding Alert

Question: Does Medicare have specific guidelines regarding reimbursement for 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)? We're having problems documenting medical necessity for the anesthesia.

Illinois Subscriber

Answer: Medicare does not have a policy regarding reimbursement for endoscopy, so local Medicare carriers are able to establish their own. Some carriers will cover the endoscopy with modifier -G8 (Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure) along with an appropriate cardiovascular diagnosis (such as congestive cardiomyopathy, 425.4, or chronic myocardial ischemia, 414.8) and with a patient status of P3 (A patient with severe systemic disease) or higher. Call your local carrier or log on to its Web site to check endoscopy policies.