Here are seven updates and key points on billing for colonoscopy procedures.
Colonoscopy anesthesia
1. Beginning in 2018, CMS updated the CPT code for screening colonoscopies to CPT 00812, describing "anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy" so Medicare knows to waive the deductible and co-insurance for the anesthesia service, according to Ciproms Medical Billing.
2. In some cases, screening colonoscopies become diagnostic colonoscopies, which means the anesthesia code must be updated to CPT 00811 describing "anesthesia for lower intestinal endoscopic procedures, endoscopy introduced distal to duodenum; not otherwise specified" with the PT modifier and Medicare only waives the deductible.
3. The updates to colonoscopy anesthesia codes either kept the base units flat or increased them for upper GI procedures; however, for lower GI procedures the base units drop by one or two points, according to Ciproms Medical Billing.
Colonoscopy
4. When colonoscopies don't completely reach the splenic flexure, they should be coded as sigmoidoscopies, according to Outsource Strategies. The failed procedures should be referenced as "incomplete" and coded as CPT 45378 with the right G-code modifier for a failed procedure.
5. CMS requires a separate modifier for coding a screening colonoscopy that turns into a diagnostic procedure when polyps are found and removed. CPT 45385 is the colonoscopy code used with a PT modifier when the procedure becomes diagnostic; in those cases, don't use the G-code for screening, according to Out Source Strategies. Keep an eye on commercial payer contract guidance on screening-turned-diagnostic procedures as well.
6. CMS reduced screening colonoscopy reimbursement from five to three base unit values, a 40 percent reduction leading to a 28 percent reimbursement decrease, according to Anesthesia Resources.
7. Bleeding control is included in biopsy and most other endoscopic procedures, according to Stephanie Ellis, president of Ellis Medical Consulting. The procedure isn't separately billable unless the patient arrives at the center with a GI bleed as the reason for a procedure being performed.