Gastroenterology Coding Alert

In its annual update of Medicare payment rules and the physician fee schedule database, CMS made the following rule changes of interest to gastroenterologists:
 
Screening flexible sigmoidoscopies performed by nurse practitioners, physician assistants and clinical nurse specialists will now be reimbursed. Payment will be 80 percent of the allowable fee to physicians. The non-physician providers must also be authorized under state law to perform the procedure.
 
The American Medical Associations specialty society relative value update committee (RVUC) recommended increases in the work relative value units (RVUs) of 17 gastrointestinal endoscopy codes; CMS accepted seven. The endoscopy codes that will receive an increase in work value in 2002 include 43239 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) (interim only), 43244 ( with band ligation of esophageal and/or gastric varices), 43255 ( with control of bleeding, any method), 43263 (endoscopic retrograde cholangiopancreatography [ERCP]; with pressure measurement of sphincter of Oddi [pancreatic duct or common bile duct]), 43265 ( with endoscopic retrograde destruction, lithotripsy of calculus/calculi; any method), 43269 ( with endoscopic retrograde removal of foreign body and/or change of tube or stent) and CPT 45380 (colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) (interim only).
 
The 2002 Medicare conversion factor, which when multiplied by a procedures RVU yields the unadjusted Medicare payment for a procedure, has been lowered 5.38 percent to 36.1992 from last years 38.2581. The 2002 Medicare physician fee schedule database is available for download at www.hcfa.gov/medicare/pfsmain.htm.
 
The full text of the CMS final rule changes is available in the Nov. 1, 2001, Federal Register.