Anesthesia coding conference: Five tips to achieve EGD claims success

Anesthesia coding conference: Five tips to achieve EGD claims success

Reporting your anesthesiologist's work during an upper gastrointestinal endoscopy, esophagogastroduodenoscopy (EGD), or colonoscopy procedure is a tricky issue for many medical coders. If your anesthesiologist provides service during one of these procedures, you will need to think about a number of factors in order to get reimbursed. Here are five expert tips to help you submit worry-free EGD claims.

Clear anesthesia coverage with payers Insurance companies have differing points of view on whether they reimburse for EGD anesthesia. That is why verifying your payer's policy is a good starting point. Many payers think about EGD conscious sedation anesthesia to be the responsibility of the endoscopist or gastroenterologist. These payers are of the opinion that the endoscopist can supervise a qualified person to monitor the patient and administer pain medication during the procedure. As a matter of fact, reimbursement is covered in the endoscopist's global fee.

Look for crosswalks with 00810 and 00740 The code range for EGD and esophagogastroduodenoscopies ) cross to anesthesia code 00740. You will also report 00740 for ERCP services. Colonoscopy surgical codes 45378-45392 cross to 00810.

Ensure Dx points to medical necessity Many a time, denials for colonoscopy anesthesia happen as the diagnosis does not meet the payer's criteria for payment. Some insurance companies will repay for anesthesia during the service, however they need documentation supporting medical necessity like physical status modifier of P3 or higher. Other payers list precise conditions and diagnosis codes that you must use to merit anesthesia payment.

For diagnosis support use V codes The V-code section of ICD-9 may offer help in providing the right diagnosis codes. You may be in the habit of using V codes as secondary codes only, however for some EGD and colonoscopy cases the V code might be the only apt primary diagnosis.

Be ready to appeal By including support diagnoses and physical status modifiers, you may help get your EGD claims approved without difficulty. However you may also have to appeal some cases that get a medical review even if some payers take in anesthesia services for EGDs. To get more anesthesia coding tips, sign up for an anesthesia coding conference that's slated to take place in Orlando, FL this December

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