Gastroenterology Coding Alert

You may think you can find your way through the bundling maze for the new CPT Codes on your own, but the latest Correct Coding Initiative version 9.0 makes sure you are not left in the dark by spelling out which procedures are components of the new endoscopy codes.

Also, if you are used to coding for any anesthesia other than conscious sedation with your gastrointestinal procedures, you are out of luck. This edition bundles nerve blocks into your codes and makes sure you do not code separate procedures or "less extensive" procedures with their comprehensive codes.

Component Procedures Assigned to New Endoscopy Codes

CPT 2003 blessed the gastroenterology coding community with six much-needed endoscopy codes to report submucosal injections and dilations. CCI Edits several common procedures into each of these new codes. For example, take a look at the codes bundled into 43201 (Esophagoscopy, rigid or flexible; with directed submucosal injection[s], any substance):

 

36000* Introduction of needle or intracatheter, vein

Venipuncture (36410)

37202 Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic, vasoconstrictive)

43200 Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

Spinal cord injections (62318-62319)

Nerve blocks (64415, 64417, 64450-64475)

Add-on code +69990 Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)

90780 Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour.

Of special interest concerning the new codes is the fact that the submucosal injection codes are not bundled into the polypectomy codes, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel. "Therefore, physicians should bill both codes when it is necessary to raise up a polyp with submucosal injections to safely remove it with the snare," he says. CMS threatens to bundle this procedure if it sees that these codes are being used in a higher-than-expected percentage of cases.

You will find listed in the chart of page 11 all additional bundles for each new CPT endoscopy code. Simply flip through a copy of the CCI to find more detailed information.

Stick to Conscious Sedation for GI Procedures

Gastroenterologists commonly use conscious sedation for most of their endoscopy procedures. However, CCI makes sure to limit any use of other forms of anesthesia with most gastrointestinal procedures. You cannot report 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter ...) with most GI codes, and general anesthesia codes (00520, 00740, 00810, 00902) cannot be used for the new endoscopies and the new code 46706 (Repair of anal fistula with fibrin glue).

"If they have bundled these codes it is because they feel that the surgeon doing the endoscopy procedure is capable of IV sedation," says Barbara Johnson, CPC, MPC, Loma Linda University Anesthesiology Medical Group, Loma Linda, Calif. She states that most gastroen-terologists would not use regional nerve blocks anyway; the edits, however, discourage the use of general anesthesia with these procedures.

Other Pertinent Changes

G0272. The edits bundle the new HCPCS code G0272 (Naso/oro gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]) into many of the incision, excision and repair codes.

0008T. This Category III code defines an "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with suturing of the esophagogastric junction." Do not code separately for this procedure with 43400 (Ligation, direct, esophageal varices), 43401 (Transection of esophagus with repair, for esophageal varices) and gastrectomies (43620-43622, 43638-43639).

44701. This new CPT code for colonic lavage is bundled as an integral part of most lower GI procedures.

Fluoroscopy (76000). CCI reminds coders that fluoroscopic guidance is designated as a separate procedure and bundled into GI procedures. Do not report fluoroscopy with endoscopic procedures (43232, 43242, 45342).

Hernia Repair Codes Affected

Hernia repair codes for neonates and infants under 5 years (49491-49501) receive several bundled procedures. For 49491 (Repair, initial inguinal hernia, preterm infant [less than 37 weeks gestation at birth], performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible) and 49492 (... incarcerated or strangulated), CCI bundles several procedures in addition to 64416:

38500 Biopsy or excision of lymph node(s); open, superficial

44005 Enterolysis (freeing of intestinal adhesion) (separate procedure)

44200 Laparoscopy, surgical; enterolysis (freeing of intestinal adhesion) (separate procedure)

Excision or suture of mesentery (44820-44850)

49255 Omentectomy, epiploectomy, resection of omentum (separate procedure)

49650 Laparoscopy, surgical; repair initial inguinal hernia

55041 Excision of hydrocele; bilateral.

CCI only bundles 64416 and 55041 into the remaining hernia repair codes (49495-49501).