Gastroenterology Coding Alert

Question: Can the CPT^® code ‘76975’ be used on all gastrointestinal endoscopic procedures other than procedures described by CPT^® codes 43231,43232,43237,43238,43242,45341 and 45342? What are the documentation requirements?

New York Subscriber

Answer: As with most coding, this is case by case. When you are reporting any procedure and the code descriptor says, “with endoscopic ultrasound examination,” you should not report 76975 (Gastrointestinal endoscopic ultrasound, supervision and interpretation) separately. For example, if you see the guidelines for reporting 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate), it carries an instruction not to report it with 76975. You also want to be sure you aren’t unbundling by breaking up a code like 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination)to report components separately.

Diagnostic tests require an order, and according to CPT^® guidelines:

• All diagnostic ultrasound examinations require permanently recorded images with clinically indicated measurements.
• A final, written report should be issued for inclusion in the patient's medical record.
• Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.

Coding tip: If your gastroenterologist performs any endoscopic procedure and uses ultrasound guidance during the procedure, it is best to look at the individual code that you will report for the procedure to see if imaging guidance is included in the procedure and to see the guidelines if the imaging has to be reported separately.