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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

March 2018

Update: Monitored Anesthesia Care for GI for Endoscopic Procedures


Harvard Pilgrim is updating our commercial Monitored Anesthesia Care for Gastrointestinal (GI) Endoscopic Procedures Medical Policy to include the appropriate 2018 CPT codes and to expand coverage of monitored anesthesia care to include patients at risk of complication due to mild systemic disease.

2018 coding

The following 2018 CPT codes have been added to the policy and are effective for dates of service beginning Jan. 1, 2018:

  • 00731 — Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum, not otherwise specified
  • 00732 — Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum, endoscopic retrograde cholangiopancreatography (ERCP)
  • 00811 — Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum, not otherwise specified
  • 00812 — Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum, screening colonoscopy including any surgical removals such as polyps.
  • 00813 — Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum

The following deleted CPT codes have been removed from the policy:

  • 00740 — Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum
  • 00810 — Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

Criteria update

In addition, the criteria have been updated to allow for monitored anesthesia care for patients at a lower level of risk for complications. Previously, for monitored anesthesia care for upper or lower GI endoscopy to be considered medically necessary, in addition to meeting other criteria, the patient must have an increased risk for complications due to severe co-morbidity corresponding to the American Society of Anesthesiologists (ASA) Physical Status Modifier of P3 or greater (severe systemic disease). For dates of service beginning March 30, 2018, that threshold will be P2 or greater (mild systemic disease), when other coverage criteria are met.
For complete information, please refer to the updated commercial Monitored Anesthesia Care for Gastrointestinal (GI) Endoscopic Procedures Medical Policy.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator