Anesthesia Coding Alert

Question: Our physician was providing anesthesia during a screening colonoscopy when the gastroenterologist perforated the colon. The patient was transported from the ambulatory surgery center to the hospital for a follow-up procedure to repair the colon. The payer has denied our claim because they have already paid the inpatient claim that was billed by another provider. What is the proper way to bill the anesthesia for the colonoscopy in the ASC?

Minnesota Subscriber

Answer: Your case was prior to the hospital procedure, so the claim for your provider’s service should be paid.

You should appeal the denial. Start by verifying that your coding is correct. Here’s a starting point, based on the information you have shared:

• 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified)
• An appropriate diagnosis with the finding
• K91.71 (Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure)

Important: If the procedure was aborted due to the perforation, list diagnosis code Z53.8 (Procedure and treatment not carried out for other reasons) before K91.71.

Make a notation in Box 19 to explain the situation, such as “Patient received treatment at another facility for puncture.”

Also be sure that you’re reporting the correct type of anesthesia. Conscious sedation is often used for a colonoscopy, whereas the hospital procedure was probably a general anesthetic with intubation.