Wiki Anesthesia for screening colonoscopy

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Bernadette10

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Sharing some advice I got from an auditor that has been very helpful:

Medicare and Medicare Replacement:

Anesthesia for a screening colonoscopy is coded 00812 and the primary diagnosis is Z12.11.

Anesthesia for a colonoscopy that started as screening and becomes diagnostic is coded as 00811 with modifier PT. The primary diagnosis is Z12.11 followed by the diagnosis based on the findings (i.e. colon polyp K63.5).

Private Insurance:

Anesthesia for a screening colonoscopy is coded 00812 and the primary diagnosis is Z12.11.

Anesthesia for a colonoscopy that started as screening and becomes diagnostic is coded as 00811 with modifier 33. The primary diagnosis is Z12.11 followed by the diagnosis based on the findings (i.e. colon polyp K63.5).
 
Bernadette10 said:
Sharing some advice I got from an auditor that has been very helpful:

Medicare and Medicare Replacement:

Anesthesia for a screening colonoscopy is coded 00812 and the primary diagnosis is Z12.11.

Anesthesia for a colonoscopy that started as screening and becomes diagnostic is coded as 00811 with modifier PT. The primary diagnosis is Z12.11 followed by the diagnosis based on the findings (i.e. colon polyp K63.5).

Private Insurance:

Anesthesia for a screening colonoscopy is coded 00812 and the primary diagnosis is Z12.11.

Anesthesia for a colonoscopy that started as screening and becomes diagnostic is coded as 00811 with modifier 33. The primary diagnosis is Z12.11 followed by the diagnosis based on the findings (i.e. colon polyp K63.5).
Click to expand...

I'm an anesthesia coder. For commercial insurance, screenings that turn diagnostic are coded with 00812-PT unless otherwise required by the insurance. For BCBSTX, they require 00812-33 for this scenario.
 
Per the 2022 Crosswalk:
"Anesthesia for screening colonoscopy is reported with code 00812. When screening colonoscopy becomes diagnositic procedure, per
CMS report 00811 with the PT modifier."
 
janellefinnie@sbcglobal.net said:
Per the 2022 Crosswalk:
"Anesthesia for screening colonoscopy is reported with code 00812. When screening colonoscopy becomes diagnositic procedure, per
CMS report 00811 with the PT modifier."
Click to expand...
For Medicare & Medicare Advantage Plans, 00811-PT is the correct ASA code for screening colonoscopy that turns diagnostic.

For commercial plans, 00812-PT is used per the insurance companies with a few exceptions (ie., BCBS TX).
 
LisaAlonso23 said:
For Medicare & Medicare Advantage Plans, 00811-PT is the correct ASA code for screening colonoscopy that turns diagnostic.

For commercial plans, 00812-PT is used per the insurance companies with a few exceptions (ie., BCBS TX).
Click to expand...
Hello Lisa, Can you share where you found the BCBSTX info please? I've searched their payor policies, with no luck. Thank you!
 
Looking for some clarification on anesthesia for a colonoscopy screening turned diagnostic when they also perform an EGD - would you still use the 00812 or would you use the 00813?
 
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