GI Endoscopy Anesthesia

The autocoder codes GI endoscopy anesthesia on a dedicated GI path. It selects one primary anesthesia code from 00811, 00812, 00813, 00731, 00732, 00320, and 00326. It then records intent, therapy, payer, and the final code in the rationale field on the claim.

Combined upper and lower scopes (00813)

The autocoder combines the scopes automatically. When the case produces an upper endoscopy code (00731) and a lower endoscopy code (00811 or 00812) from the same session, and the selected primary code is one of those codes, the autocoder replaces the primary code with 00813. It merges the rationales of both scopes and keeps the note citations from both.

The autocoder attaches the gi_codes_combined_00813 alert on every combine. The alert is INFORMATIONAL at severity 2. It asks a coder to confirm that one combined code matches the documented session. The alert names the codes that were merged.

Combination does not apply to 00732 (ERCP), 00320, or 00326.

Screening, surveillance, and diagnostic intent

The autocoder classifies colonoscopy intent as screening, surveillance, or diagnostic. It reads the documented indication and the primary payer, then applies the payer tables shipped with the product. Some payers treat a surveillance case as diagnostic. The autocoder applies those payer positions and states the result in the rationale.

Intent drives the diagnosis codes. On a pure screening or surveillance colonoscopy, the autocoder puts the screening code Z12.11 first. When a screening colonoscopy converts to a therapeutic procedure, Z12.11 stays first and the polyp or lesion code follows. On a combined 00813 case, the upper GI diagnosis takes the first position and Z12.11 is retained as a supportive diagnosis, because both procedures need a supporting diagnosis.

If a later step removes that screening code from a combined case, the autocoder attaches the gi_screening_dx_dropped alert (INFORMATIONAL, severity 3). It asks a coder to confirm the removal and restore the code if the colonoscopy portion was screening or surveillance.

PT modifier on 00813

Payer positions on PT differ, so the autocoder decides PT at claim build. It keeps PT on 00813 only for payers on a short exception list, and it attaches gi_00813_pt_kept_exception (INFORMATIONAL, severity 1) so a coder can confirm the payer match. For every other payer, and for any payer with a Medicare or Medicaid marker, the autocoder bills 00813 bare and attaches gi_00813_pt_stripped (INFORMATIONAL, severity 2). It also removes PT from any anesthesia code outside 00811, 00812, and 00813 and attaches anes_pt_invalid_code_stripped (INFORMATIONAL, severity 2).

Your facility configuration controls the exception list through the claimValidation.giCombinedPtExceptionPayers setting. A facility list replaces the shipped list completely, so it must name every exception payer. Contact your Hank representative to change it.

Reading the rationale

Every GI claim carries a rationale in a fixed shape, so you can scan it fast. It states the scope, the intent and why, whether therapy occurred, the payer bucket, and the final code with or without PT. Read the rationale first when you audit a GI case. It shows why the autocoder chose the code before you re-read the record.

How this reaches you

What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, an INFORMATIONAL alert is recorded with no action required. Organizations that consume the coding API directly decide in their own workflow which alerts pause a claim, who reviews them, and when a claim is released.