Want to report gastrointestinal (GI) anesthesia accurately? We have just the code for you! Most non-surgical procedures usually don’t require anesthesia. However, doctors sedate patients for some screening tests like colonoscopy to reduce their discomfort. While some procedural codes cover anesthesia, GI colonoscopy is unfortunately not one of them.
So, how can you report a separate anesthesia service? With CPT code 00812! The description of this code is simple, so the billing process should be straightforward, right? But that is not always the case. Are your patients also complaining about being charged for anesthesia when they shouldn’t be? Read on to learn how to use this code correctly.
CPT Code 00812 – Description
CPT code 00812 refers to a separate GI anesthesia service. This code is quite straightforward. You can use it to report that a healthcare provider sedated a patient during a lower intestinal screening procedure, particularly a colonoscopy.
Since a gastroenterologist inserts a colonoscope (thin tube with a camera) in the patient’s large intestine via the anus and rectum, it is common for the patient to feel cramping, pressure, discomfort, or even pain in some cases. Hence, healthcare providers administer anesthesia to help patients relax.
CPT code 00812 is commonly used by anesthesiologists or Certified Registered Nurse Anesthetists (CRNAs) to receive compensation for their services. Billing teams also use this code for documentation purposes.
Scenarios Where CPT Code 00812 is Applicable
Need more explanation? Let us explain some practical scenarios for CPT code 00812. Did you know that there are generally three types of colonoscopies? These procedures can be preventive (screening), diagnostic, or therapeutic.
However, CPT code 00812 is specifically used for sedation during screening colonoscopies. Here are three examples of when this code is applicable:
Screening Colonoscopy to Detect Colorectal Cancer
A 50-year-old man with a family history of colorectal cancer visits a gastroenterologist for a detailed checkup. The patient does not have any noticeable symptoms. Hence, the doctor performs a screening colonoscopy to detect precancerous polyps (abnormal growths) in the colon.
To make the patient more comfortable, an anesthesiologist administers anesthesia before inserting a colonoscope into the colon. Since this anesthesia service is not included in the procedure, the provider reports it with CPT code 00812 for separate billing and payment.
Screening Colonoscopy to Monitor Inflammatory Bowel Disease (IBD)
A 49-year-old man with a long-standing IBD, particularly Crohn’s disease, visits a hospital for a routine colonoscopy. Since his last colonoscopy was 2 years ago and he is at high risk for developing colorectal cancer, the doctor performs this screening test to monitor any changes.
However, before proceeding with this routine screening, the gastroenterologist asks a CRNA to sedate the patient to minimize discomfort. The billing team then uses CPT code 00812 to bill for this GI anesthesia.
Screening Colonoscopy for a Patient with a Prior Polyp Removal
Let’s consider a different scenario! Assume a 56-year-old patient visits a gastroenterology department. The unique thing about his case is that he previously had a screening colonoscopy 5 years ago, during which the gastroenterologist found and removed a polyp (a small clump of cells that form along the lining of the colon).
Due to this medical history, the doctor concludes that the patient is at high risk of developing more polyps. He then immediately performs a screening colonoscopy to detect these abnormal growths. A CRNA administers anesthesia to make the patient more comfortable before the procedure and uses CPT code 00812 to report this service.
CPT Code 00812 – Billing & Reimbursement Guidelines
Want to avoid coverage issues? Follow these key billing and reimbursement guidelines for CPT code 00812.
Understand the Basic Application Requirements
The key rule for billing is to understand the basic requirements. This includes understanding the appropriate use of procedural codes. Keep in mind that CPT code 00812 is only applicable for screening colonoscopies for asymptomatic patients.
If a screening colonoscopy becomes diagnostic, anesthesia services are reported with a different CPT code (00811) along with a PT or 33 modifier, depending on the payers — Medicare or private insurance companies.
Maintain Complete Documentation
Another key requirement? Document everything that led to the administration of anesthesia, including:
- Patient’s medical history
- Current condition
- Procedure details (colonoscopy)
This will help you justify the medical necessity of sedating a patient. Also, don’t forget to include details about anesthesia, such as:
- Medicine details
- Patient preparation
- Anesthesia time
Apply Appropriate Anesthesia Modifiers
Anesthesia Modifiers can help you communicate who performed the service. Therefore, use of the following modifiers with CPT code 00812 to indicate the provider’s role:
- Modifier AA: Use this modifier when an anesthesiologist personally administers the anesthesia.
- Modifier QX: Append this modifier to CPT code 00812 when a CRNA provides anesthesia under a physician’s supervision.
- Modifier QY: Apply this modifier when an anesthesiologist directs one of the CRNA during the process.
- Modifier QZ: Use this modifier when a CRNA administers anesthesia without any supervision.
Follow Payer-Specific Rules
Each payer may have a unique policy for preventive services and anesthesia coverage. For example, Medicare requires you to add modifier 33 to CPT code 00812 if you provide anesthesia for a colorectal cancer screening (HCPCS code G0105 or G0121).
In short, the federal program completely covers this service if the colonoscopy remains a screening. Other insurers may impose different restrictions. Therefore, verify each insurance company’s requirements before administering anesthesia and billing CPT code 00812.
Avoid Common Mistakes
Healthcare providers often make the common mistake of separately billing for anesthesia when they have administered pain relief medication and performed a colonoscopy themselves.
To put it simply, in this case, insurance companies consider anesthesia as part of the screening procedure. In short, Medicare only provides separate payment for CPT code 00812 when an anesthesiologist or a CRNA is involved in the procedure.
CPT Code 00812 vs. 00813
Both CPT codes 00812 and 00813 refer to anesthesia services provided during gastrointestinal (GI) services. However, they are not the same and apply to different procedures. Let’s uncover their key differences.
Description
CPT code 00812 covers anesthesia services specifically for screening colonoscopy. In contrast, CPT code 00813 applies to anesthesia administration during both upper and lower intestinal endoscopy within the same session.
Types of Procedures
CPT code 00812 exclusively reports anesthesia services for a screening colonoscopy — a procedure performed to visualize the lower part of the digestive tract. In contrast, CPT code 00813 points towards anesthesia services during all types of endoscopies (screening, diagnostic, and therapeutic).
Specificity
Another key difference between the two is that CPT code 00812 is more specific. Whereas CPT code 00813 highlights anesthesia services for many endoscopies.
Base Units
Both CPT codes 00812 and 00813 have different base units — standardized values assigned to anesthesia procedures by the Centers for Medicare & Medicaid Services (CMS) for determining the reimbursement amount. The base units for CPT code 00812 are 3, while CPT code 00813 has a value of 5.
Simplify Anesthesia Billing
To conclude, CPT code 00812 is a popular anesthesia code introduced in 2018. Anesthesiologists or Certified Registered Nurse Anesthetists (CRNAs) typically use this code to inform payers about the anesthesia services provided during screening colonoscopies. We hope that you are now familiar with this code.
You can use our reimbursement guidelines to bill for your time and effort. But if you are still uncertain, the good news is that we also offer anesthesia billing services. With a team of certified professional coders (CPCs), MediBillMD is ready to handle your coding!
