Gastroenterology Coding Alert

Question: When I coded 00810 for anesthesia service during an esophagogastroduodenoscopy (EGD), my claim got denied. The physician's note said the request was due to the patient's symptoms, but no other details were provided. What did I do wrong?

South Carolina Subscriber

Answer: For one, you could look into your coding for the patient's condition. Your diagnosis code should indicate the coexisting medical condition that justifies an anesthesiologist's involvement in the case, not the gastrointestinal condition leading to the endoscopy.

You could verify with the anesthesiologist if the patient had any of the following condition:

a) history of or anticipated intolerance to standard sedatives; or

b) Increased risk for complication due to severe comorbidity (American Society of Anesthesiologists [ASA] class III physical status or greater. See Appendix for physical status classifications which can be found in the CPT manual.)

c) Patient of extreme age, under one year or over 70; or

d) Pregnancy; or

e) History of drug or alcohol abuse; or

f) Parkinson's disease (332.0); or

g) Heart conditions (such as 410.xx, Acute myocardial infarction or 427.41, Ventricular fibrillation); or

h) Mental retardation (318.x);or

i) Seizure disorders (such as 780.39, Other convulsions);or

j) Anxiety (such as 300.0x, Anxiety states);or

k) Uncooperative or acutely agitated patients (e.g., delirium, organic brain disease, senile dementia); or

l) Increased risk for airway obstruction due to anatomic variant including any of the following:

History of stridor or sleep apnea; or Dysmorphic facial features, such as Pierre-Robin syndrome or trisomy-21; or

Presence of oral abnormalities including but not limited to a small oral opening (less than 3 cm in an adult), high arched palate, macroglossia, tonsillar hypertrophy, or a non-visible uvula; or

Neck abnormalities including but not limited to short neck, obesity involving the neck and facial structures, limited neck extension, decreased hyoid-mental distance (less than 3 cm in an adult), neck mass, cervical spine disease or trauma, tracheal deviation, or advanced rheumatoid arthritis; or

Jaw abnormalities including but not limited to micrognathia, retrognathia, trismus, or significant malocclusion.