Gastroenterology Coding Alert

Stretta also straps down permanent code in January If reporting the Stretta procedure is causing you difficulties, CPT is getting ready to unveil a permanent new code for the procedure that will make this task easier.

At press time, CPT had not released the official list of its additions and deletions for 2005. However, sources have indicated that there will be several new CPT codes in 2005 relevant to gastroenterology practices, including a new code for Stretta and two codes for colonoscopies with endoscopic ultrasound. EUS, Fine Needle Colonoscopies Get Recognized In January, CPT will begin accepting the following colonoscopy codes:

45391 - Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination

45392 - Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s). There are several instances in which a coder may find these CPT additions handy, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel.

45391 explained: "A gastroenterologist will occasionally encounter an unusual finding during a colonoscopy, where there is a mass suspected under the surface of the intestine. These lesions can be assessed with the aid of an ultrasound device that is part of a colonoscope," Weinstein says.

45392 explained: "In other instances, the gastroenterologist may perform these procedures to determine the depth of an invasion of a cancerous mass seen visually with a standard colonoscope. If necessary, it is also possible to biopsy a lesion through the wall of the colon using the ultrasound pictures to guide the needle into the area of concern," Weinstein says.

In the past, coders were most likely to use an unlisted-procedure code (e.g., 45999, Unlisted procedure, rectum) when reporting these types of procedures. While most offices still don't have the instruments to perform EUS and fine needle colonoscopies, the procedures are gaining wider use, Weinstein says.

Stretta Emerges From Category III CPT 2005 will also sport a shiny new code for the Stretta procedure, which a gastroenterologist would perform on a patient with gastroesophageal reflux disease (GERD). When the gastro performs the Stretta procedure in 2005, you should report 43257 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease). Stretta Coding Still Evolving The introduction of the 43257 code is just the latest in a long and complicated coding history for the Stretta procedure. In 2004, CPT gave Stretta Category III (temporary) status and its own code, 0057T (Upper gastrointestinal endoscopy, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with delivery of thermal energy to the muscle of the lower [...]