Gastroenterology Coding Alert

Overcome this coding challenge Reporting for Crohn's patients can make your head spin, but it doesn't have to be that difficult. We-ve consulted with the experts to help you increase your reimbursement for Crohn's diagnosis, management and treatment.
 
Crohn's disease, also called ileitis or regional enteritis, is an inflammatory bowel disease (IBD) that typically irritates the small intestine but can also be found in any part of the digestive tract. Those with Crohn's disease have frequent pain from intestinal inflammation and often have diarrhea. There is no cure for Crohn's disease, but several treatments are available.
 
In many gastroenterology offices, not much time passes between visits from patients with Crohn's disease, says Lois Curtis, CPC, of Gastroenterology Associates in Evansville, Ind.
 
-You go in spurts sometimes: You get a lot (of Crohn's patients), and then it tapers off a while,- she says. -But we-re always getting patients with Crohn's or diagnosing patients with it.- 1. Identify the Consultation Visits Often a gastroenterologist's first encounter with a Crohn's patient is a -referral.- The patient has some sort of gastroenterological problem, and her primary-care physician decides that a gastroenterologist's opinion is needed.
 
Even if another physician diagnoses a patient with Crohn's and she eventually comes under your office's care, the initial meeting with her is still a consultation.
 
If the patient reports initially because she (or her doctor) decided that a gastroenterologist's opinion was in order, choose the appropriate code from the outpatient consultation codes 99241-99245 (Office consultation for a new or established patient ...).
 
-This is how most patients with Crohn's symptoms end up on our office's appointment books,- says Delia Bartolotto-Stewart, CPC, of Digestive Health Physicians in Fort Myers, Fla. -A patient has a pain or diarrhea problem, the (primary-care) doctor isn't sure if it's Crohn-s, so our office determines that.-
 
If the gastroenterologist provides a second or third opinion about a patient with Crohn's symptoms, you should assign one of the outpatient office visit codes (99201-99205 for new patients, or 99211-99215 for established patients) or consult codes (99241-99245), whichever is appropriate for your setting and type of service. 2. Code the Diagnostic Method Gastroenterologists have several options when testing for Crohn's disease. They can order simple blood tests to measure for an abnormally high number of white blood cells or a high sedimentation rate, a sign of inflammation somewhere in the body. They can also order fecal-occult blood tests to detect intestinal bleeding, a problem common to Crohn-s.
 
Physicians most often use the guaiac-based fecal-occult test because of its sensitivity to lower-bowel bleeding. The proper CPT code for this test is 82270 (Blood, occult, by peroxidase activity [e.g., guaiac],  qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening).

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