Gastroenterologists Fight Reduced Medicare Reimbursement for Upper GI EUS With Fine Needle Aspiration or Biopsy
Published on Thu Mar 01, 2001
Although gastroenterologists were initially pleased with the creation of several new CPT codes for endoscopic ultrasound, these codes no longer permit separate reporting of radiological supervision and interpretation services. The lack of a separate radiological code and the lower relative value unit (RVU) assigned by HCFA to some of the new codes has decreased Medicare reimbursement for an endoscopic ultrasound (EUS) with fine needle aspiration/biopsy (FNA/B) performed in the upper gastrointestinal tract. This has caused some gastroenterologists to delay reporting the new codes. The new rectal EUS codes, however, offer superior Medicare reimbursement over the old codes and are being used immediately.
No Separate Radiological Code to Report
In CPT 2000, 43259 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination) was the only EUS code available and could only be used to report upper gastrointestinal procedures. In addition, the code covered only the ultrasound portion of the procedure and did not include the fine needle biopsy or aspiration that is often performed during the EUS.
In response to complaints from gastroenterologists, CPT 2001 created the following new codes for EUS and EUS with FNA/B:
43231 esophagoscopy, rigid or flexible; with endoscopic ultrasound examination
43232 ... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)
43242 upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)
45341 sigmoidoscopy, flexible; with endoscopic ultrasound examination
45342 ... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)
Each of these new codes contains a cross-reference at the end of the definition that states, do not report 76975 [gastrointestinal endoscopic ultrasound, supervision and interpretation] in conjunction with the EUS procedures. The old EUS code, 43259, still contains a cross-reference at the end of its definition that allows the separate reporting of the radiological supervision and interpretation code.
Use CPT 2000 Codes for Upper GI EUS With FNA/B
The end result of these new codes and the RVUs that have been assigned to them is that reimbursement for an upper gastrointestinal endoscopy with EUS and FNA/B is lower with the new CPT 2001 codes. You now get paid more for doing a [surgical] PEG tube placement [43750] than for an ultrasound examination, says Roy Ligresti, MD, director of endoscopic ultrasound at New York Medical College in Valhalla, N.Y.
Under CPT 2000 guidelines, Ligresti would have billed an upper gastrointestinal endoscopy with EUS and [...]
