Gastroenterology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: How do you code for a rectal endoscopic ultrasound?

Jusuf Zlatanic, MD
New York, N.Y.

  Answer: Use code 76872 (echography, transrectal) to bill for this procedure, says Kathryn L. Cianciolo, MA, RRA, CCS, CCS-P, a coding consultant for the American Health Information Management Association (AHIMA) in Waukesha, Wis., and past chair of the Society for Clinical Coding.

This service has both a technical component and a professional component, explains Cianciolo. The technical component represents the value assigned to the ownership and maintenance of the equipment and the use of any technicians. For a gastroenterologist to bill for the technical component of any diagnostic service, he or she must own (or partially own by being a partner in a practice) the equipment being used.

The professional component represents the gastroenterologists interpretation of the test results. When the gastroenterologist only does the interpretation of the rectal endoscopic ultrasound, then he or she may bill for reimbursement of the professional component by attaching modifier -26 (professional component) to code 76872.

If the gastroenterologist both owns the equipment and interprets the test results, he or she may bill for reimbursement of both the technical and professional components using code 76872 without any modifier.

Gastroenterologists may be tempted to use code 76975 (gastrointestinal endoscopic ultrasound, radiological supervision and interpretation) to bill for this procedure. That code, however, is used only when the ultrasound is done in conjunction with a gastrointestinal endoscopic procedure, according to Cianciolo.