Anesthesia Coding Alert

Question: We have only one diagnosis to support using anesthesia during a screening colonoscopy; the other diagnoses/findings are related to an upper GI endoscopy (K44.9 and K29.70). Should we include modifier 33 or modifier PT when we file? The insurance is commercial.

Wisconsin Subscriber

Answer: According to rules introduced in 2017, commercial insurers do not recognize modifier PT (Colorectal cancer screening test converted to diagnostic test or other procedure). Because of this, your best option is to append modifier 33 (Preventive services) if the payer will accept it. Reporting a screening colonoscopy with 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy) alerts the insurance company to the fact that the patient’s co-pay and deductible should be waived.

Medicare note: Medicare only accepts modifier PT in conjunction with anesthesia code 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified). You’ll be denied if you submit PT with either 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy) or 00813 (Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum).