Details and specificity are the pillars of medical billing. There are hundreds of procedures across different specialties that require the physician to sedate the patient.
That’s not all, there is a unique code for anesthesia administration for each of these surgical procedures. Besides, these codes have their specific reimbursement and billing guidelines.
Understanding the gravity of it is optimal if you are an anesthesia provider struggling with higher denials, payment delays, and a strained revenue cycle.
This guide will cover everything you need to know about CPT code 00812. Master when and when not to report it by reading this guide till the end!
What is CPT Code 00812?
CPT code 00812 covers anesthesia administration for a patient undergoing a screening colonoscopy.
During this procedure, a gastroenterologist inserts a flexible, long tube with a camera into the rectum for examination. Thus, sedation is an integral part that offers comfort to the patient.
Appropriate Use Cases for CPT Code 00812
Let’s explore a few real-world clinical scenarios where CPT 00812 applies:
Routine Age-Based Screening
Picture a 52-year-old male patient scheduled for his first routine colorectal cancer screening due to his age. He does not have any family or personal history of colon or polyp cancer. Besides, he is healthy and asymptomatic.
Thus, the anesthesiologist administers anesthesia throughout the screening coloscopy to ensure the patient’s safety, comfort, and immobility.
Here, the anesthesiologist will report CPT code 00812 to bill for the services.
Screening Due to Family History
Assume a 47-year-old female patient with a family history of colon cancer. For context, her mother was diagnosed at age 55 with the disease. Thus, the gastroenterologist has scheduled her for a screening colonoscopy.
The anesthesiologist administers and monitors anesthesia from the time the patient is prepped for the procedure until the recovery phase begins.
Here, CPT code 00812 applies.
Screening with High Risk/Complexity
Imagine a 62-year-old male patient with a history of severe chronic obstructive pulmonary disease (COPD) and obesity. He has come for a scheduled routine age-based screening colonoscopy.
The gastroenterologist requested the anesthesiologist to manage the patient’s airways and vitals during the sedation due to his comorbid conditions.
Thus, the anesthesiologist administers anesthesia. He also manages the patient’s complex physiological status while the gastroenterologist performs the screening colonoscopy.
Here, CPT code 00812 applies.
Modifiers to Append with CPT Code 00812
When billing for anesthesia services, you must append the appropriate modifier to indicate who performed the services.
Modifier AA
Report CPT code 00812 with modifier AA when an anesthesiologist himself administers the anesthesia during the screening colonoscopy.
Modifier QX
What happens when a qualified non-physician anesthetist administers anesthesia under the direct supervision of a physician? You report the service with modifier QX.
Modifier QY
What if an anesthesiologist provides medical direction to one certified registered nurse anesthetist (CRNA) for successful anesthesia administration? Report CPT code 00812 with modifier QY.
Modifier QZ
This modifier indicates that the CRNA provided anesthesia service without any medical direction from a physician.
Reimbursement Guidelines for CPT Code 00812
The following are the key billing and reimbursement guidelines related to CPT 00812:
Ensure Comprehensive Documentation
Your documentation must justify that the physician performed the colonoscopy for preventive reasons to ensure timely reimbursement against the CPT code 00812.
Discussed below is a brief overview of what the documentation should include:
Time Documentation
Your standard anesthesia documentation must clearly state pre-anesthesia evaluation, the start and stop times, total units, and all monitored physiological parameters.
Diagnosis-Procedural Code Match
The primary diagnosis code submitted with the anesthesia service (CPT code 00812) must be an encounter or screening code to support the preventive intent.
Clinical Indication
The patient’s medical record must clarify that the gastroenterologist performed the colonoscopy as part of a routine preventive care plan (patient must be asymptomatic).
Do Not Report 00812 If Screening Converts to Diagnosis
Note that CPT code 00812 is only for screening colonoscopy procedures that are part of a preventive care plan. Simply put, it is for asymptomatic patients.
There is another anesthesia code (CPT 00811) available for scenarios in which the screening colonoscopy converts into a diagnosis. Besides, you must also append modifier 33 or PT to indicate the conversion.
Understand Payer-Specific Policies
Reimbursement guidelines and documentation requirements significantly vary across government programs (Medicare, Medicaid) and commercial payers.
Thus, you must communicate with the relevant payer to understand the specific policies surrounding CPT 00812. It is an essential step to prevent payment delays and denials.
Final Thoughts on CPT Code 00812
With that said, it is time to conclude the guide. However, before we conclude, let’s revisit some key pointers. First, before billing this code, you must ensure that the performed colonoscopy was for preventive reasons only. If yes, only then report CPT code 00812.
If it was initially started as a screening service but turned into a diagnostic procedure, report 00811 instead and append modifier 33 or PT (whichever the payer recognizes) with it.
Additionally, you must append the relevant anesthesia modifier to indicate to the payer who performed the service. These include modifiers AA, QX, QY, and QZ.
Having trouble following through all these details? Think about outsourcing anesthesia billing services to professionals like NeuraBill.
