Anesthesia Coding Alert

Question: What is the correct way to bill screening colonoscopies that become diagnostic colonoscopies for commercial insurance and Medicare Advantage? The coders in our office agree with Medicare changing to 00811 with modifier PT, but we are not sure if we are supposed to bill the other insurance companies the same as Medicare.

Louisiana Subscriber

Answer: Coding is never a one-size-fits-all situation because you should always take individual details into consideration. That said, when a screening colonoscopy results in a procedure, in most cases you should report 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified) with modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure) to Medicare and 00812 (… screening colonoscopy) with modifier PT to commercial insurers. Be sure to check the individual payer’s anesthesia coding policies before submitting the claim since some may have specific requirements for you to fulfill.