Use of Anesthesia Services for Routine Gastrointestinal Endoscopy

The following Association Technology Evaluation Criteria must be met for a service/supply to be
considered for coverage:
1. The technology must have final approval from the appropriate government regulatory
bodies;
2. The scientific evidence must permit conclusions concerning the effect of the technology on
health outcomes;
3. The technology must improve the net health outcome;
4. The technology must be as beneficial as any established alternatives;
5. The improvement must be attainable outside the investigational setting.

Coding:
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

Description of Procedure or Service:
Intravenous sedation and analgesia is routinely administered for gastrointestinal endoscopic
examinations to help alleviate patient anxiety and discomfort. Provision of sedation and
analgesia for endoscopy procedures is standard practice. In the United States, licensed registered
nurse or physician assistant administration of intravenous opiate narcotic, usually meperidine
(Demerol®), in combination with a benzodiazepine, usually midazolam (Versed®), under the
direct supervision of a licensed physician endoscopist is the traditional method for achieving
sedation.

Recently propofol (Diprivan®) has been used as an alternative method of sedation for patients
undergoing endoscopy procedures. Propofol is a short-acting anesthetic agent. The advantages
of propofol are its rapid induction of sedation, quicker patient recovery time, and anti-emetic
effect. The use of propofol requires monitoring for respiratory and/or cardiac collapse by trained
personnel.