Awareness : Did You Know? 2017

Did You Know? Weekly Educational Series #17

For the Week of June 12, 2017-Anesthesia with Endoscopic GI

There are three options to Anesthesiologist, in 2017, to code and bill endoscopic gastrointestinal anesthesia procedures.

  1. 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum): You will code and bill EGD (or esophagogastroduodenoscopy), using CPT code 00740, which carries a base value of 5 units.
  2. 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified): Use 00790 for gastric procedures or laparoscopic gallbladder procedures, which carries a base value of 7 units.
  3. 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum): Use 00810 for anesthesia during a colonoscopy, which also carries a base value of 5 units as with 00740.

Most anesthesiologists administer MAC (monitored anesthesia care) during these procedures instead of general anesthesia. When administering MAC you need to append the QS modifier (Monitored anesthesia care service) for Medicare patients. You could also append modifier G9 (Monitored anesthesia care for a patient who has a history of severe cardio-pulmonary condition), if it is supported by the documentation in the medical record. Important: The diagnosis that supports anesthesia should be tied to a co-existing medical condition, not the gastrointestinal condition that led to the procedure. Diagnoses that could possibly support your anesthesiologist’s work include:

  • Parkinson’s disease (G20)
  • Heart conditions (such as the codes from I21, ST elevation [STEMI] and non-ST elevation [NSTEMI] myocardial infarction, or I49.01, Ventricular fibrillation)
  • Mental sub-normality or retardation (F70-F79, …Intellectual disabilities)
  • Seizure disorders (such as R56.9, Unspecified convulsions)
  • Anxiety (such as F41.1, Generalized anxiety disorder).
  • Below are two examples:

    Example 1: If the gastroenterologist performs an EGD and colonoscopy during a single session and the anesthesiologist documents a combined start/end time of 60 minutes, then either code 00740 or 00810 can be billed for the total amount of time, because each have the same base value of 5.

    Example 2: The gastroenterologist performs an upper intraperitoneal procedure or laparoscopy during the same session as an EGD or colonoscopy. Because code 00790 carries a base unit value of 7, you’ll submit 00790 instead of 00740 or 00810, with the combined total time for both procedures.