Harvard Pilgrim Anesthesia for GI Endoscopic Procedures Policy Update

March 2018 ~

Harvard Pilgrim is implementing updates to its policy for Monitored Anesthesia Care for Gastrointestinal (GI) Endoscopic Procedures 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.

According to the insurer, effective for dates of service beginning January 1, 2018, the following CPT^® coding changes have been made to its Monitored Anesthesia Care for GI Endoscopic Procedures policy:

Added CPT^® Codes

• 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

Deleted CPT^® Codes

• 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

Additionally, Harvard Pilgrim has updated the policy’s criteria 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 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, refer to the updated commercial Monitored Anesthesia Care for Gastrointestinal (GI) Endoscopic Procedures Medical Policy.

CPT^® is a registered trademark of the American Medical Association.

Source(s): Harvard Pilgrim Network Matters;