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Tag Archives: 00812

00811, 00812 and 00813

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I bill for Florida based anesthesia providers. I have seen some MCR denials for 00813 when a screening colonoscopy was performed with EGD and the screening colonoscopy turned diagnostic. I have been billing 00813 with modifier PT without Z12.11 or Z80.010. Mcr states modifier used is inappropriate with 00813.
Any help is appreciable. Not sure of any new Medicare guidelines if any. Please update. Appreciate !!

Medical Billing and Coding Forum

ASA base units for 00811 and 00812 for commercial payers

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Can the ASA base units for 00811 and 00812 be raised to 5 units for commercial payers?

Per Anesthesia Guidelines on pg. xi in the RTV guide states

Any procedure around the head, neck, or shoulder girdle, requiring field avoidance, or any procedure requiring a position other than supine or lithotomy, has a minimum Base Value of 5 regardless of any lesser base value assigned to such procedure in the body of the Relative Value Guide.

Thanks!

Medical Billing and Coding Forum

00811 00812 Colonoscopy Anesthesia Coding

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When reporting anesthesia for a screening colonoscopy, the appropriate code is 00812 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy. When reporting 00812 for a Medicare beneficiary, Medicare will waive the deductible and coinsurance, for the patient. On occasion, a service that begins as a screening colonoscopy will reveal the […]
AAPC Knowledge Center

New CPT codes 00811 and 00812 for Anesthesia administered during colonoscopy procedures

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Anesthesia services furnished in conjunction with and in support of a screening colonoscopy are reported with CPT code 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy). CPT Code 00812 will be added as part of January 1, 2018 HCPCS update. Effective for claims with dates of service on or after January 1, 2018, Medicare will pay claim lines with new CPT code 00812 and waive the deductible and coinsurance. 

When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia services are reported with CPT code 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscopy introduced distal to duodenum; not otherwise specified) and with the PT modifier. CPT code 00811 will be added as part of the January 1, 2018 HCPCS update. Effective for claims with dates of service on or after January 1, 2018, Medicare will pay claim lines with new CPT code 00811 and waive only the deductible when submitted with the PT modifier.


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