Gastro Focus: Scope Out 4 Steps to Streamline Gastro Anesthesia Coding
Supporting medical necessity and reading-through policies help clear the way.
In case your anesthesiologist offers care during endoscopic gastrointestinal procedures, you don't have many codes to remember. Paying attention to those choices and the best supporting diagnoses, though, will help ease your gastro claims every time. Read this expert medical coding article and know what anesthesia CPT codes and ICD-9 codes apply. Start With the Correct Crosswalk Choices
CPT,‚® divides anesthesia CPT codes for endoscopic gastrointestinal procedures by "upper" and "lower." Your three primary choices are as follows:
00740 ,¬EURoe (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum (for EGD, or esophagogastroduodenoscopy))
00790 -- (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified (for laparoscopy))
00810 -- (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum (for colonoscopy))
You should bill MAC anesthesia on your upper endoscopies and colonoscopies. There are only two anesthesia CPT codes that you should bill out for: 00740 and 00810." Modify it: While coding for monitored anesthesia care (MAC), don't forget to include MAC modifiers as required. For Medicare patients, append modifier QS (Monitored anesthesia care service) to the procedure code. You might also require to report modifier G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition), depending on the patient's medical history. Dig Deeper for Diagnosis Supporting Medical Necessity
Payers look for diagnoses that validate administering anesthesia during EGDs or further gastro procedures. Your claim must include a diagnosis that specifies a co-existing medical condition that supports the anesthesiologist's involvement, not simply the gastrointestinal condition leading to the procedure.
Potential diagnoses could contain:
Parkinson's disease (332.0)
Heart conditions (such as 410.xx, Acute myocardial infarction or 427.41, Ventricular fibrillation)
Mental subnormality or retardation (318.x)
Seizure disorders (such as 780.39, Other convulsions)
Anxiety (such as 300.0x, Anxiety states).
You might also be able to submit a diagnosis for failed sedation attempts: 995.24 (Failed moderate sedation during procedure) or V15.80 (Personal history of failed moderate sedation). Narrow Multiple Procedure Options to a Single Code
The gastroenterologist might carry out more than one procedure during the encounter, but then that doesn't mean you submit multiple anesthesia CPT codes. Guideline: CPT,‚®'s anesthesia guidelines for separate or multiple procedures educate you to report the "most complex" procedure. The American Society of Anesthesiologists commends you bill the "anesthesia code with the highest base unit value." Both resources, on the other hand, direct you to report the combined (or total) time for all procedures with a single anesthesia CPT code.
In case your anesthesiologist offers care during endoscopic gastrointestinal procedures, you don't have many codes to remember. Paying attention to those choices and the best supporting diagnoses, though, will help ease your gastro claims every time. Read this expert medical coding article and know what anesthesia CPT codes and ICD-9 codes apply. Start With the Correct Crosswalk Choices
CPT,‚® divides anesthesia CPT codes for endoscopic gastrointestinal procedures by "upper" and "lower." Your three primary choices are as follows:
You should bill MAC anesthesia on your upper endoscopies and colonoscopies. There are only two anesthesia CPT codes that you should bill out for: 00740 and 00810." Modify it: While coding for monitored anesthesia care (MAC), don't forget to include MAC modifiers as required. For Medicare patients, append modifier QS (Monitored anesthesia care service) to the procedure code. You might also require to report modifier G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition), depending on the patient's medical history. Dig Deeper for Diagnosis Supporting Medical Necessity
Payers look for diagnoses that validate administering anesthesia during EGDs or further gastro procedures. Your claim must include a diagnosis that specifies a co-existing medical condition that supports the anesthesiologist's involvement, not simply the gastrointestinal condition leading to the procedure.
Potential diagnoses could contain:
You might also be able to submit a diagnosis for failed sedation attempts: 995.24 (Failed moderate sedation during procedure) or V15.80 (Personal history of failed moderate sedation). Narrow Multiple Procedure Options to a Single Code
The gastroenterologist might carry out more than one procedure during the encounter, but then that doesn't mean you submit multiple anesthesia CPT codes. Guideline: CPT,‚®'s anesthesia guidelines for separate or multiple procedures educate you to report the "most complex" procedure. The American Society of Anesthesiologists commends you bill the "anesthesia code with the highest base unit value." Both resources, on the other hand, direct you to report the combined (or total) time for all procedures with a single anesthesia CPT code.
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