Medicare Compliance & Reimbursement

Question: Is a certified registered nurse anesthetist (CRNA) allowed to bill Medicare for anesthesia during a colonoscopy? Are there certain requirements?

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. If the payer requires MAC modifiers, append as applicable: QS (Monitored anesthesia care service), 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 cardiopulmonary condition).››

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 leng th.

Take note: The October 2011 CPT Assistant clarified that the CPT® standard for time measurement applies to moderate (conscious) sedation codes 99143-99145. Per CPT®, the provider reaches a "unit of time" when he passes the midpoint. For example, a one hour unit of time is attained when 31 minutes have elapsed.