Digestive Health Associates

Southwest Endoscopy Center

Anesthesia Resources

Assessing and Documenting Medical Need for Anesthesia Services
In Patients Undergoing Gastrointestinal Endoscopy

Documentation tips

  Use the STOP-Bang screening tool to identify patients who are high risk (score ≥3) for OSA
  327.23 Obstructive sleep apnea
  780.57 Unspecified sleep apnea

  Review prior endoscopy sedation records in CORI for evidence of
  V15.80 personal history of failed moderate sedation
  Consider prior midazolam dosing as evidence of V15.80 if in excess of approved usual adult dose

      Usual Adult Dose of midazolam (FDA-approved labeling):
        Age <60 = 5 mg
        Age 60 or greater = 3.5 mg
Be aware of FDA's concern regarding the frequency and extent of adverse events reported for moderate sedation when sedation agents are administered in amounts that are higher than may be indicated on the relevant drug labeling (footnote 19).

Coding notes
Failed moderate sedation during procedure (995.24)

Anthem Anesthesia Criteria

On November 9, 2010 we received the following communication from Anthem Blue Cross and Blue Shield of Colorado, which appears to supercede Anthem's guideline information of October 13, 2010 as referenced below:
As of Nov. 1, 2010, coverage decisions will reflect a changing local standard of care. As a result, if a GI endoscopic procedure is otherwise covered, Anthem will also provide coverage for anesthesia services during lower GI endoscopic procedures such as colonoscopy (CPT 00810) and upper GI endoscopic procedures (CPT 00740)

  • Prolonged or therapeutic endoscopic procedure requiring deep sedation; or
  • A history of or anticipated intolerance to standard sedatives (e.g., patient on chronic narcotics or benzodiazepines, or has a neuropsychiatric disorder); or
  • Increased risk for complication due to severe comorbidity (American Society of Anesthesiologists [ASA] class III physical status or greater. See Appendix for physical status classifications); or
  • Patients over 70; or
  • Pediatric age group; or
  • Pregnancy; or
  • History of drug or alcohol abuse; or
  • Uncooperative or acutely agitated patients (e.g., delirium, organic brain disease, senile dementia); or
  • Increased risk for airway obstruction due to anatomic variant including any of the following:
    • History of previous problems with anesthesia or sedation; or
    • History of stridor or sleep apnea; or
    • Dysmorphic facial features, such as Pierre-Robin syndrome or trisomy-21; or
    • Presence of oral abnormalities including but not limited to a small oral opening (less than 3 cm in an adult), high arched palate, macroglossia, tonsillar hypertrophy, or a non-visible uvula (not visible when tongue is protruded with patient in sitting position e.g., Mallampati class greater than II); or
    • Neck abnormalities including but not limited to short neck, obesity involving the neck and facial structures, limited neck extension, decreased hyoid-mental distance (less than 3 cm in an adult), neck mass, cervical spine disease or trauma, tracheal deviation, or advanced rheumatoid arthritis; or
    • Jaw abnormalities including but not limited to micrognathia, retrognathia, trismus, or significant malocclusion

Propofol Shortage