General Surgery Coding Alert

Location distinguishes codes.

If your general surgeon is taking high-resolution images during endoscopy, you have new codes for the procedure starting Jan. 1.

CPT^® 2013 adds two new codes for these procedures that you had to previously report using unlisted codes.

Use 43206 and 43252 for Optical Endomicroscopy

A technological advance that your general surgeon might have started using is optical endomicroscopy to take high resolution images within optically thick tissue.

"Examination of the gastrointestinal tract with this modality has allowed a new approach for the early detection of cancer and dysplasia," says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel.

Previously, you would have used an unlisted code when your surgeon performed optical endomicroscopy, but thanks to CPT^® 2013, you’ll have codes to report the service. If your surgeon uses optical endomicroscopy for the esophagus, you can use 43206 (Esophagoscopy, rigid or flexible; with optical endomicroscopy) to report this service.

When your surgeon uses optical endomicroscopy during an EGD, you can report the procedure using 43252 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy).

Example: Your general surgeon performs an EGD to assess a patient with symptoms of an obstruction. During the procedure, your surgeon sees an area of the duodenum with some changes to its appearance. To enable him to visualize the areas within the tissue, he decides to use optical endomicroscopy and takes high resolution images of the suspect area.

Since your surgeon viewed the esophagus, stomach and duodenum and performed high-resolution imaging, you will report the optical endomicroscopy that he performed using 43252 instead of 43206. If your surgeon doesn’t examine all the way into the duodenum or jejunum, report 43206,

Don’t Double-Dip Interpretation

Although CPT^® 2013 includes a new code for the interpretation of endomicroscopy images (88375,Optical endomicroscopic image[s], interpretation and report, real-time or referred, each endoscopic session), you’re not likely to use the code in your general surgery practice.

Codes 43206 and 43252 identify the "surgical" procedure for esophagoscopy or EGD with endomicroscopy, according to Mark S. Synovec, MD, AMA CPT Editorial Panel member speaking at the AMA’s annual CPT^® and RBRVS Symposium in Chicago.

Even so, the codes identify "both the optical endomicroscopic procedure and the interpretation and report for the specimen obtained by the same practitioner," states CPT Changes 2013, An Insider’s View.

A note following 88375 states, "Do not report 88375 in conjunction with 43206 or 43252.

Bottom line: You shouldn’t report either 43206 or 43252 with 88375 when your general surgeon performs the scope and optical endomicroscopic procedure and interpretation. Report only 43206 or 43252, which includes your surgeon’s interpretation.

Code 88375 "is intended to identify provision of the interpretation and report service for optical endomicroscopy when provided by a separate practitioner such as a pathologist," states CPT Changes 2013, An Insider’s View.

Note Additional CPT^® 2013 Endoscopy Change

Adding 43206 and 43252 isn’t the only code changes you need to know for endoscopy coding in the new year.

CPT^® 2013 also deletes a code you need to know about: 43234 (Upper gastrointestinal endoscopy, simple primary examination [e.g., with small diameter flexible endoscope] [separate procedure]).

Do this: With 43234 deleted, CPT^® instructs you to report 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) instead, according to Joel V. Brill, MD, AGAF, FASGE, FACG, CHQM, AMA CPT Advisory Committee Member speaking at the AMA’s annual CPT^® and RBRVS Symposium in Chicago.

Here’s why: Code 43234 "was originally established for reporting upper gastrointestinal panendoscopy using a small-diameter endoscope," states CPT Changes 2013, An Insider’s View. But the 43234 approach was "not highly utilized," so surgeons should now report 43235 "to identify upper gastrointestinal endoscopy," according to Insider’s View.