Medicare released an update on July 1st, 2021, that lead to several discussions on our team!
First, let’s go over the code descriptions for 00811 and 00812.
00812: Anesthesia for lower intestinal endoscopy procedures, endoscope introduced distal to duodenum; screening colonoscopy
00811: Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
CMS and most other payors included anesthesia for screening colonoscopies in their payable preventive services [found in the Medicare regulations at 410.37(a)(1)(iii)]. For qualifying services, the co-pay and deductible are waived for the anesthesia claim.
Two (2) modifiers were created to indicate that anesthesia was provided for a screening colonoscopy:
Modifier 33: Preventive service Modifier PT: Colorectal cancer screening test; converted to diagnostic test or other procedure
Anesthesia services furnished in conjunction with and in support of a screening colonoscopy are to be reported with CPT/ASA code 00812. Medicare will pay claim lines with CPT/ASA code 00812 and waive the deductible and coinsurance.
Per the National Coverage Determination 210.3 Colorectal Cancer Screening Tests: Append modifier –33 (Preventive Service) to anesthesia CPT code 00812.
For Medicare and those payers that follow Medicare policy when a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia services are reported with CPT/ASA code 00811 along with the PT modifier. Effective for claims with dates of service on or after January 1, 2018, Medicare will pay claim lines with CPT/ASA code 00811 and waive only the deductible when submitted with the PT modifier.
Remember all carriers seem to be addressing this differently and for payors other than Medicare it is important to check not only anesthesia policies but policies on preventive care.