Gastrointestinal endoscopy
is one of the safest and most commonly performed adult procedures. The
record of safety extends to the sedation or anesthesia for both upper
and lower GI endoscopy. Because of both the safety and the frequency of
the procedure, anesthesia for GI endoscopy has been under scrutiny by
health plans for a decade or more. Lately, the number of claims denied
for lack of “medical necessity” for endoscopic anesthesia services have
once again been growing. Without taking any position on the merits of
anesthesia vs. moderate sedation in connection with endoscopies and
especially colonoscopies, we would like to remind our audience of the
principles followed by payers in evaluating the medical necessity of
anesthesia for these procedures.
The differences between anesthesia and moderate sedation
Moderate sedation (aka “conscious sedation”)
is a “drug-induced depression of consciousness during which patients
respond purposefully to verbal commands, either alone or accompanied by
light tactile...
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