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2025 CPT code 00812

Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy. Report 00812 to describe anesthesia for any screening colonoscopy regardless of ultimate findings.

Per CPT guidelines, use 00812 for any screening colonoscopy regardless of findings. CMS guidelines stipulate using 00811 if the procedure becomes diagnostic. Thorough documentation is essential to support coding choices, especially when a screening becomes diagnostic, due to differences in RVU assignment between CPT and CMS.

Modifiers may be applicable to indicate specific circumstances, such as unusual anesthesia (23), medical direction (AD, QK, QY, QZ), monitored anesthesia care (G8, G9, QS), physical status (P1-P6), or CRNA services (QX, QZ). Payer-specific guidelines should be consulted.

Medical necessity for anesthesia during a colonoscopy is supported by the patient's inability to tolerate the procedure without it, due to factors such as anxiety, pain tolerance, or medical conditions.

The anesthesia provider is responsible for pre-operative evaluation, inducing and monitoring the patient during the procedure, documenting all medications and monitoring, managing patient responses, and overseeing post-anesthesia care.

In simple words: The doctor gives you medicine to make you sleep comfortably during a colonoscopy where a tube with a camera is inserted to look at your lower intestines.

The provider performs anesthesia services for a patient undergoing a screening colonoscopy during which the surgical provider introduces an endoscope into the intestines below the duodenum. The anesthesia provider performs a preoperative evaluation, induces the patient, and monitors the patient during the procedure. They document medications, monitoring, patient responses, and anesthesia times. Post-procedure, they oversee the patient's transfer to postanesthesia care.

Example 1: A 70-year-old patient undergoes a routine screening colonoscopy under anesthesia, using propofol, administered by a CRNA with medical direction by a physician., A 50-year-old patient with a history of severe cardiopulmonary condition undergoes a screening colonoscopy requiring monitored anesthesia care (MAC). The anesthesiologist bills with code 00812 and likely appends modifier G9 to indicate the patient's health status., During a screening colonoscopy under anesthesia (billed as 00812), a polyp is discovered and removed. Though the procedure becomes diagnostic, 00812 is still reported per CPT guidelines, but documentation should clearly reflect the change to a diagnostic procedure, potentially impacting reimbursement with some payers like Medicare.

Documentation must include pre-operative evaluation, type and amount of medication, monitoring methods, patient responses, start and stop times of anesthesia, and post-anesthesia care details. If the screening colonoscopy converts to a diagnostic procedure (e.g., biopsy, polypectomy), this must also be clearly documented.

** The choice between moderate/conscious sedation and deep sedation influences the need for an anesthesiologist's presence. Deep sedation, particularly using propofol, usually requires an anesthesia provider. Medicare recognizes anesthesiologists, physicians qualified under state law, CRNAs, and anesthesiologist assistants for anesthesia services.

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