Gastroenterology Coding Alert

Question: How should we report Enteryx treatments? Washington, D.C., Subscriber Answer: There is no CPT code for Enteryx treatments, so reporting methods will vary depending on the payer. Until the day there is a CPT code especially for Enteryx, call the payer and ask a representative what code he wants for Enteryx. When you call the carrier about Enteryx claims, the rep may tell you to report 43236 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection[s], any substance). On the other hand, some Enteryx coders prefer to take their chances with 43499 (Unlisted procedure, esophagus) because Enteryx is more involved than simple injection therapy, and 43499, if accepted, will result in more reimbursement. Note: At press time, there was still no code for Enteryx treatments. However, many coding experts believe that it is only a matter of time before CPT assigns a Category III code to the procedure. When you call your insurance carrier to ask how it wants Enteryx treatments reported, ask the carrier if there is a Category III code for the procedure.