Gastroenterology Coding Alert

Hint: Don’t always report the interpretation of images separately.

To accurately report the two new CPT^® 2013 codes for “optical endomicroscopy,” namely 43206 and 43252, focus on the extent of scope to understand when to apply these codes. You will also need to understand what other procedures codes you cannot separately report when your gastroenterologist performs them along with endomicroscopy.

Use Extent of Scope to Report Right Code

When your gastroenterologist performed optical endomicroscopy, your code choice will depend on what portion of the GI tract your gastroenterologist viewed and the extent to which the endoscope was introduced in the digestive tract.

If your gastroenterologist only viewed the esophagus, obtained images through endomicroscopy and he did not advance the scope into the stomach, you will report 43206 (Esophagoscopy, rigid or flexible; with optical endomicroscopy) for the procedure that was performed.

If, instead, your gastroenterologist performed an upper EGD to view the esophagus, stomach, duodenum and/or the jejunum and during the process obtained images through endomicroscopy, you will report 43252 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy) to bill out the procedure performed.

Reminder: The CPT^® codes 43206 and 43252 cover the optical endomicroscopy services, but don’t cover the supply of the contrast agent that is used in the procedure. To report the supply of the contrast agent, you will need to report the HCPCS code A9698 (Non-radioactive contrast imaging material, not otherwise classified, per study).

Don’t Report Image Interpretations Separately

When your gastroenterologist performs optical endomicroscopy and obtains images for review, don’t report the image interpretations separately. CPT^® 2013 also introduced a new code for interpretations of images obtained through optical endomicroscopy, namely 88375 (Optical endomicroscopic image[s], interpretation and report, real-time or referred, each endoscopic session).

But guidelines for 43206 and 43252 clearly state that you cannot report 88375 with either of these two codes for optical endomicroscopy. You can only report 88375 if the interpretation and reports are provided by another person (such as a pathologist). In such situations, you will report the appropriate endomicroscopy code, 43206 or 43252, for the services performed by your gastroenterologist and 88375 for the services provided by the pathologist.

Example: Your gastroenterologist sees a patient who has been suffering from recurrent and long-standing GERD and known Barrett’s esophagus with indeterminate dysplasia from a prior endoscopic examination. Your gastroenterologist had previously suggested lifestyle changes along with prescribing H2 receptor blockers to help control the reflux. After the diagnosis of Barrett’s esophagus, your gastroenterologist put the patient on a therapy of proton pump inhibitors and after a few months a follow-up, endoscopy was ordered. 

During the endoscopy, your gastroenterologist decided to perform optical endomicroscopy to check for tissue changes and to see if there are any definite dysplastic changes. Using a 10 percent IV fluorescein sodium as the contrast agent, your gastroenterologist captures images of the area with tissue changes. The scope is removed without extending it to view the areas of the stomach. The images are sent to the pathologist for interpretations.

Your pathologist interprets the images and reports a diagnosis of Barrett’s esophagus with no dysplastic changes.

What to report: You report the optical endomicroscopy that your gastroenterologist performed with 43206 and the supply of the contrast agent with A9698. Since your pathologist interpreted the images and provided a report, if you are reporting his services, you will report 88375 for his work.