Anesthesia Coding Alert

Question: Can a certified registered nurse anesthetist (CRNA) bill Medicare for anesthesia during a colonoscopy? If so, are there certain requirements that must be met?

New Jersey Subscriber

Answer: Yes, a CRNA can bill Medicare for colonoscopy, although several carriers do not recognize anesthesia as medically necessary for endoscopies. If you file a claim, the correct code depends on the type of sedation administered.

• For general anesthesia or monitored anesthesia care (MAC), report 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum). Reporting MAC is appropriate if the carrier recognizes that anesthesia service is medically necessary for the procedure or if you plan to bill the patient.
• For moderate sedation, choose from 99148 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of age, first 30 minutes intra-service time), 99149 (... age 5 years or older, first 30 minutes intra-service time), and +99150 (...each additional 15 minutes intra-service time [List separately in addition to code for primary service]). Your choice will be based on the patient’s age and the procedure length.
• Some payers require moderate sedation modifiers when you submit these claims. You might need to append modifier QS (Monitored anesthesia care), G8 (Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure), or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition).