Anesthesia Coding Alert

One main reason for the increased focus on 00810 and 00740 is a recent Aetna policy change. The national carrier tried to cut its reimbursement for these codes, stating that anesthesia services are not necessary for routine endoscopy.

Aetna did define some comorbidities that would allow reimbursement for anesthesia services, such as significant obesity and significant heart or lung disease.

After a big backlash from providers worried about patient safety issues and the possibility that patients would be less willing to undergo this important screening test, Aetna reinstated its more lenient policy. But it has promised to readdress the policy later this year. Blue Cross Blue Shield is following suit, Lane says.

The policy change is being delayed until a new drug -- Fospropofol -- is available. In May, manufacturers will be asking for FDA approval -- minus a warning that this drug needs to be administered by personnel trained in general anesthesia.

RNs may be able to administer the new drug, Lane says. And of course moderate sedation -- provided by the surgeon -- would limit the need for anesthesiologists in these endoscopic services.