Gastroenterology Coding Alert

Although the latest Correct Coding Initiative (CCI) version 8.3 adds several infusions to the list of bundled procedures, the edits, which are effective Oct. 1, 2002, leave most gastroenterology practices untouched. Code 90780 Joins the Bundling Fury The trend in current CCI edits, especially for surgical procedures, is that injection services are being bundled into the more extensive procedures with which they are performed. This is an obvious attempt by CMS to increase the standard of care. They reason that when a lesser-valued procedure is always performed with a more extensive procedure, it becomes an integral part of the higher-valued procedure and therefore should not be billed separately. The most extensive edit involves code 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour). 90780 is used to report the first hour of IV infusion, while 90781 is an add-on code for each additional hour. The edit bundles the infusion into most gastroen-terological procedures (40490-49906). This means that the component procedure, or infusion, will not be reimbursed when it is rendered by the same physician on the same date of service. It is now part of the comprehensive procedure.

This may seem hard on doctors, but many coders urge that this will not greatly affect gastroenterologists. "It won't affect my coding at all, because we don't use that code in conjunction with our gastro procedures," says Margaret Lamb, RHIT, CPC, Great Falls Clinic, Great Falls, Mont. Rarely during their regular GI procedures (scopes) has she coded for an intravenous infusion related to the scope. IVs are mainly used for sedation.

Lamb holds that her clinic usually only uses the intravenous infusion with "unrelated procedures." Lamb notes only one instance of billing an intravenous code when the doctor did an infusion of albumin following a therapeutic paracentesis (49080). She agrees with the CCI edits that "if you are doing a concurrent infusion, it should be part of the procedure performed and not reimbursed separately."

Another way that this edit may affect you is in the treatment of Crohn's disease. Lois Curtis, CPC, billing manager, Gastroenterology Associates, Evansville, Ind., says she has only heard of code 90780 being used for Remicade infusions for Crohn's patients. Remicade is often used in the treatment of moderate to severe Crohn's patients who do not respond to standard treatments. Most insurance plans cover this treatment but now will not pay for it when billed separately. Bust the Bundle With Modifier -59 Fortunately, the edits indicate that coders can override the new gastroenterology bundles by using a modifier. Lamb says that "the only way around the new CCI edit is if it truly is being done separately from the GI [...]