Anesthesia Coding Alert

Question: I’m coding anesthesia for a screening colonoscopy and EGD with biopsy at a single encounter. Do I use the same anesthesia code for both or code them separately?

Washington Subscriber

Answer: You should report single code 00813 (Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum) for the anesthesia services in this colonoscopy and esophagogastroduodenoscopy (EGD) encounter. Code 00813 has 5 base units, according to both the American Society of Anesthesiologists (ASA) and Medicare.

Details: CPT^® Anesthesia section guidelines state you should report the anesthesia code that crosses to the most complex procedure when the patient has multiple surgical procedures during a single anesthetic administration.

What’s more, in the case of 00813, both upper (EGD) and lower (colonoscopy) gastrointestinal scope procedures are listed in the descriptor, making it the most appropriate code for the encounter. The fee calculation based on the time for both procedures will ensure accurate reimbursement because you will use the combined time.

If you reported the anesthesia services separately, that would be incorrect coding and also would affect reimbursement, bringing incorrect payment and unwanted attention from payers.

Learn more: If you were reporting anesthesia for a screening colonoscopy alone, the correct code would be 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy). Code 00812 has 4 base units in the ASA Relative Value Guide^®. Tip: This code is rare because it has a different number of base units, 3, in the Medicare 2022 base units file available at www.cms.gov/Center/Provider-Type/Anesthesiologists-Center. So, you need to know which base units your payer uses when you calculate expected payment for 00812.

The code for the EGD with biopsy is 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple). If you were reporting anesthesia for only the EGD, you would report 00731 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified). Code 00731 has 5 base units, according to ASA and Medicare.

Some payers may have their own guidelines for reporting these services, so be sure to check payer policy.