ICD-9 CM Diagnosis Codes that Support Medical Necessity

 EMPIRE MEDICARE'S POLICY FOR ANESTHESIA AND GASTORINESTINAL ENDOSCOPY

ICD-9 CM Diagnosis Codes that Support Medical Necessity

It is not enough to link the procedure code to a correct, payable ICD-9-CM diagnosis code. The diagnosis or clinical suspicion must be present for the procedure to be paid. Below are diagnosis codes that support medical necessity.

ICD-9 Code           ICD-9 Description 
 290.11-290.13  Presenile dementia
 290.20-290.21  Senile dementia with delusional or depressive features
 290.3  Senile dementia with delirium
 290.40-290.43   Arteriosclerotic dementia
 290.8  Other specified senile psychotic conditions
 290.9   Unspecified senile psychotic condition
 291.0-291.5   Alcoholic psychoses
 291.81-291.89   Other specified alcoholic psychosis
 291.9  Unspecified alcoholic psychosis
 292.0  Drug withdrawal syndrome
 292.11-292.12   Paranoid and/or hallucinatory states induced by drugs
 292.2  Pathological drug intoxication
 292.81-292.89   Other specified drug-induced mental disorders
 292.9  Unspecified drug-induced mental disorder
 293.0  Acute delirium

Gastrointestinal Endocopy anesthesia procedure

 EMPIRE MEDICARE'S POLICY FOR ANESTHESIA AND GASTORINESTINAL ENDOSCOPY 

Patients undergoing gastrointestinal endoscopy receive medications for anxiety, discomfort and anesthesia, as well as monitoring during the procedure. 

CPT Codes

00740       Anesthesia for upper gastrointestinal endoscopic procedures

00810       Anesthesia for intestinal endoscopic procedures

HCFA's National Policy

Anesthesia by the performing surgeon is not separately reimbursable to the surgeon.

Indications and Limitations of Coverage and/or Medical Necessity

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Patients undergoing upper and lower gastrointestinal endoscopy frequently receive medication for sedation, relief of anxiety and discomfort. "General anesthesia or the presence of an anesthesiologist is rarely indicated except in special circumstances. The endoscopy team should be trained in cardiopulmonary resuscitation." (Preparation of Patients for Gastrointestinal Endoscopy, Guidelines for Clinical Application, American Society Gastrointestinal Endoscopy, publication #1016).

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