CPT Code 00811: Anesthesia for Lower Intestinal Endoscopy

Learn when to use the 00811 CPT code and enhance your understanding to improve your billing accuracy.

Table of content

What is CPT code 00811?CPT code 00811 documentation requirements CPT code 00811 billing guidelines Other relevant CPT codes

Use Code

What is CPT code 00811?

CPT code 00811 is used to report anesthesia services provided during high-complexity lower intestinal endoscopic procedures. This includes screening colonoscopies or diagnostic colonoscopies where advanced interventions are performed, such as complex polypectomies, stent placements, or prolonged procedures due to patient conditions or anatomical challenges.

The endoscope is introduced distal to the duodenum, usually for evaluation or treatment within the colon or rectum. When a screening colonoscopy is converted to a diagnostic or therapeutic procedure, the proper use of modifier PT and high-complexity anesthesia codes, such as 00811, is essential for accurate billing.

When to use CPT code 00811

This code is reported when:

The anesthesia for lower intestinal endoscopy is deemed high complexity due to factors like procedure duration, patient comorbidities, or intervention intensity.
A general anesthesia or deep sedation is administered by a qualified provider such as an anesthesiologist or certified registered nurse anesthetist (CRNA).
The endoscopic procedures (endoscope introduced distal) to the duodenum involve significant clinical considerations, such as unstable vitals or risk of perforation.

CPT code 00811 documentation requirements

To ensure accurate billing and meet payer criteria, the following must be documented:

Detailed pre-anesthetic assessment, including ASA classification
Procedure performed (e.g., 45385 for therapeutic colonoscopy)
Start and end times of anesthesia
Monitoring methods and agents used (e.g., inhaled anesthetic, IV sedation)
Medical necessity and complexity indicators (e.g., patient age, morbid obesity, multiple biopsies)

Ensure that documentation is maintained when a screening colonoscopy is converted into a therapeutic one, which supports the use of 00811 with the modifier PT.

CPT code 00811 billing guidelines

Base units (4): This means that CPT code 00811 is valued with 4 base billing units, reflecting the complexity of the anesthesia service for a high-risk colonoscopy.
Report time in 15-minute increments: You should bill for anesthesia time in 15-minute blocks, starting from the time you begin preparing the patient and ending when the patient is safely in recovery.
Append appropriate modifiers: Use the correct modifier based on who provided the anesthesia:
- -AA: If an anesthesiologist personally performed the anesthesia
- -QZ: If a CRNA provided it without physician direction
Use CPT 00811 only for high-complexity cases: Bill this code only if the colonoscopy is complex, such as those involving multiple procedures, a high-risk patient, or a lengthy operation.
Use CPT 00812 for simpler cases: If the colonoscopy is routine or only moderately complex (like a basic screening with no complications), use CPT 00812 instead.

Other relevant CPT codes

00812 – Moderate complexity colonoscopy
99152–99153 – Moderate sedation by proceduralist (not anesthesia provider)

Frequently asked questions

When should the 00811 CPT code be used instead of the 00812 for intestinal endoscopic procedures?

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.

What happens if a screening colonoscopy is converted to a diagnostic procedure during the exam?

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.

How do modifiers affect claims for Medicaid services when a patient undergoes a colonoscopy?

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.