CPT Code 00811: Anesthesia for Lower Intestinal Endoscopy

CPT code 00811 should be used when the endoscope is introduced for lower intestinal endoscopic procedures involving high complexity, such as multiple polyp removals or prolonged procedures. Use 00812 for moderate complexity or routine cases. It's important to ensure compliance with payer-specific rules regarding anesthesia levels and procedure type.

If a screening colonoscopy is converted to a diagnostic or therapeutic procedure (e.g., removal of a lesion), providers should apply modifier PT to indicate the transition. This is especially relevant for Medicare beneficiaries, as it can affect coverage and cost-sharing obligations. Proper coding ensures the claim accurately reflects the change in service type.

When a patient undergoes a colonoscopy with anesthesia, modifiers are essential to accurately reflect who performed the service and the complexity of the procedure. For Medicaid services, using modifier PT or provider-specific modifiers (e.g., -QZ, -AA) helps ensure compliance and proper reimbursement. Always check your state Medicaid guidelines for modifier use in intestinal endoscopic procedures.