Question: Please provide insight on the new anesthesia codes for GI endoscopies when a screening turns diagnostic. Also, how would you report anesthesia when the patient has both an EGD and a screening colonoscopy during the same session?
Answer: Coding guidelines can differ according to the type of insurance the patient has.
GI procedure starts as a screening and turns diagnostic:
Medicare requires code 00811 (anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified) with modifier PT (colorectal cancer screening test converted to diagnostic test or other procedure). SupportMed will append this PT modifier to your claim.
For private insurers, unless they follow Medicare guidelines or have a policy similar to Medicare, you may report 00812 (anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy) unless otherwise specified. CPT coding guidelines offer a clue to this tactic by noting, “Report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings.”
If the patient has both an EGD and a screening colonoscopy during the same encounter, report 00813 (anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscopy introduced both proximal to and distal to the duodenum) and SupportMed will append modifier 33 which shows the intent of the procedure was preventative.