Anesthesia services - Gastrointestinal endoscopy - CPT 00740 , 00810

 Use of Anesthesia Services for Routine Gastrointestinal Endoscopy

As a general rule, benefits are payable under Blue Cross and Blue Shield of Alabama health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be

considered for coverage:

1. The technology must have final approval from the appropriate government regulatory bodies;

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;

3. The technology must improve the net health outcome;

4. The technology must be as beneficial as any established alternatives;

5. The improvement must be attainable outside the investigational setting.

Coding:

CPT Codes:

00740 Anesthesia for upper gastrointestinal endoscopic procedures,

endoscope introduced proximal to duodenum

00810 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum.

Description of Procedure or Service:

Intravenous sedation and analgesia is routinely administered for gastrointestinal endoscopic examinations to help alleviate patient anxiety and discomfort. Provision of sedation and analgesia for endoscopy procedures is standard practice. 

In the United States, licensed registered nurse or physician assistant administration of intravenous opiate narcotic, usually meperidine (Demerol®), in combination with a benzodiazepine, usually midazolam (Versed®), under the direct supervision of a licensed physician endoscopist is the traditional method for achieving sedation.

Recently propofol (Diprivan) has been used as an alternative method of sedation for patients undergoing endoscopy procedures. Propofol is a short-acting anesthetic agent. 

The advantages of propofol are its rapid induction of sedation, quicker patient recovery time, and anti-emetic effect. The use of propofol requires monitoring for respiratory and/or cardiac collapse by trained personnel.

Appendix D – Requested Professional CPT and HCPCS

Procedure Codes

Code         Description        Modifiers to Report 

00740        Anesthesia           NONE 

Subset: West TN counties no MHSA

Time Period: Incurred YTD          Jan - Oct, 2014       In Network? (Yes =1, No=0)

Provider Name    Provider NPI ID    Provider City    Provider Zip   Provider State Code    Visits Provider Prof

Kimberlin, Gibson D. 1932100740 PARIS 38242 TN 1

PID segment definition

SEQ    LEN     DT      OPT   RP/#  TBL#      ITEM#    ELEMENT NAME

29 26 TS O 00740 Patient Death Date and Time

PWX-00740 codepage_name is not a recognized codepage.

Explanation: The code page name on the PowerExchange configuration file was not recognized.

System Action: PowerExchange returns an error code and message, and abends.

User Response: The codepage name should be one of the standard codepages such as, IBM-037 or a user codepage name such as USRCP01. Correct the codepage name in the PowerExchange configuration file and resubmit.

Average risk screening: Lack of symptoms and abnormalities

X Screening, by definition, is a service performed on a patient in the absence of signs and symptoms.

X Medicare’s definition of average risk is no personal history of adenomatous polyps, colorectal cancer or inflammatory bowel disease, including Crohn’s disease and ulcerative colitis; no family history of colorectal cancers or an adenomatous polyp, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

X For most payors, a patient is eligible for screening colonoscopy on or after age 50. Some payors allow for screening to begin at age 45 for patients of certain gender and/or ethnic origin. If there are questions, check the summary of plan documents (SPD) and/or the plan’s coverage policies.

X Since Jan. 1, 2011, Medicare waives the co-pay and deductible for the professional and facility fees for screening colonoscopy at 100 percent with no patient financial responsibility.

X In the final rule for 2015, Medicare expanded the waiver of co-pay and deductible to include anesthesia for screening colonoscopy. A -33 modifier should be added to the 00810 anesthesia code to indicate the circumstance was preventive. 

This coverage “trumps” local contractor medical necessity policies now in existence in a screening circumstance. In the circumstance when a screening procedure becomes therapeutic (see next bullet), the PT modifier should be applied to the anesthesia service. A copay will still apply, but the deductible should be waived.

X If the screening colonoscopy is negative, a follow-up procedure is allowed every 10 years by Medicare. The frequency for follow-up for commercial payors is dependent upon the patient coverage/plan, but most follow either CMS policy or the U.S. Multi-Specialty Task Force (MSTF) recommendations.

X Billing for a screening colonoscopy in an average risk patient:

• Medicare: G0121


HCPCS/CPT Codes

00810 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

81528 – Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or
negative result

82270 – Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided 3 cards or single triple card for
consecutive collection)

G0104 – Flexible Sigmoidoscopy

G0105 – Colonoscopy (high risk)

G0106 – Barium Enema (alternative to G0104)

G0120 – Barium Enema (alternative to G0105)

G0121 – Colonoscopy (not high risk)

G0328 – Fecal Occult Blood Test (FOBT), immunoassay, 1–3 simultaneous

G0464 – Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin
(e.g., KRAS, NDRG4 and BMP3)

Medicare Beneficiary Pays

81528, 82270, G0104, G0105, G0121, G0328, and G0464:

* Copayment/coinsurance waived

* Deductible waived

Append modifier -33 to the anesthesia CPT code 00810 when you furnish a separately payable anesthesia service in conjunction with a screening colonoscopy (G0105 and G0121) to waive Medicare beneficiary copayment/coinsurance and deductible.

Appendix D – Requested Professional CPT and HCPCS

Procedure Codes

Code Description Modifiers to Report

00170 Anesthesia NONE

00400 Anesthesia NONE

00740 Anesthesia NONE

00790 Anesthesia NONE

00810 Anesthesia NONE

00840 Anesthesia NONE

01400 Anesthesia NONE

01480 Anesthesia NONE

01961 Maternity-Csection NONE

01967 Maternity-Normal NONE

11100 Biopsy, skin lesion 50, 51, 52, AS, AN, ZZ 

00785 ALCAINE       

00790 ALCOHOL

00800 ALCOHOL ISOPROPYL

00805 ALCOHOL RUBBING

00810 ALCON

00825 ALDACTAZIDE

00830 ALDACTONE

00845 ALDOMET

00850 ALDORIL

00866 ALFENTA

00903 ALKALINIZING AGENT

00915 ALKERAN

00960 ALLEREST

00976 ALLERGAN

00980 ALLERGY RELIEF OR SHOTS

00982 ALLERHIST

01000 ALLERPHED C EXPECTORANT

01001 CLARITIN D

01002 NEXIUM

01003 ANAPROX DS

01004 ATUSS EX

01005 ALLERPHED SYRUP

01006 FERRIMIN

01007 TIKOSYN

01008 ZONEGRAN

01012 BUDESONIDE

01014 CORVERT

01016 ADVIL MIGRAINE

01017 BACTRIM DS

01018 MONSEL'S SOLUTION

01019 NIFEDICAL XL

01020 OPTIVAR

01021 BUTORPHANO

d00805 METHAMPHETAMINE

d00806 PHENTERMINE

d00809 PHENDIMETRAZINE

d00810 DIETHYLPROPION

d00813 BENZOCAINE TOPICAL

d00817 HYDROXYCHLOROQUINE

d00824 OPIUM

d00825 LEVORPHANOL

d00833 OXYMORPHONE

d00838 BUTORPHANOL

d00839 NALBUPHINE

d00840 BUPRENORPHINE

d00842 SALSALATE

d00843 SODIUM SALICYLATE

d00844 SODIUM THIOSALICYLATE

d00846 MAGNESIUM SALICYLATE

d00848 DICLOFENAC 

00805 ALCOHOL RUBBING

00810 ALCON

00825 ALDACTAZIDE

00830 ALDACTONE

00835 ALDOCLOR

00845 ALDOMET

00850 ALDORIL

00866 ALFENTA

00880 ALKA-SELTZER

00960 ALLEREST

00976 ALLERGAN 

0780 NORMAL(1l)=AN0*BN0-CNO*DNO

00790 NORMAL(2,1)=CNO*FNO-ENO*8N0

00800 NJRMAL(3,1)=ENO*DNO-ANO*FNO

00810 TYPE 9900,NORMAL

00820 CALL MArMUL(3lV3,DIRCOSNORMAL,NGRMA)

00830 TYE 930tNORMA

00840 9900 FJRMAI(!X,3F10.3)

00850 C

0086V CONST=57.29577951


00870 C

00880NORk4AG=SQRT(NORKA(11f)**2+NOPMA(2t1)**2+NORMA(3,1)**2)

0890 C

00900 DIP=ACOS(ABS(NORMA(3,1)/NORMAG))*CONST

00910 lF(NORMA(1,1).EQ.0.U)STRDIR='N'

00920 IF(NORMA(2,1).E.0.0 )STRDIR='E'

00930 IF(NORMA(2,1)+N0RMA(ll).NE.0.C)GO TO 35