Monday, June 7, 2010

CPT 43273, 74261,96570 AND 96571 - Update in CPT

CPT changes for 2010
In addition to the changes prescribed by CMS in the 2010 final rule, several changes were made to the Current Procedural Terminology (CPT) used to report gastroenterology services for 2010 based on the work of the GI societies and their advisers through the American Medical Association’s (AMA) CPT process. The changes are included in the CPT 2010 code book. Note that underlined words/phrases in code descriptors throughout the article represent new changes. The changes are outlined below.

Cholangioscopy/Pancreatoscopy 

 The GI societies advocated that code 43273 be used for an add-on procedure to one or more endoscopic retrograde cholangiopancreatography (ERCP) services provided on the same day, including code 43262, ERCP with sphincterotomy. CMS concurred and implemented the recommended language as follows:
+43273    Endoscopic cannulation of papilla with direct visualization of common bile duct(s) and/or pancreatic duct(s) (List separately in addition to code(s) for primary procedure) (Use 43273 in conjunction with 43260-43265, 43267-43272)

CT Colonography
In place of the current two Category III codes (0066T and 0067T) to describe computed tomographic colonography (CTC), three Category I codes have been created: two codes to describe a diagnostic CTC study performed either without contrast (74261) or with contrast, including non-contrast images if performed (74262); and one code to describe a screening CTC study (74263).

A non-contrast CTC diagnostic study is of value in those patients for whom an instrument colonoscopy of the entire colon is incomplete due to an obstructing neoplasm. A contrast-enhanced diagnostic study may be useful in some patients after incomplete endoscopy to characterize indeterminate colonic masses or to better visualize colonic segments containing excess fluid.

The new CTC descriptor includes the phrase “including image post processing,” to clarify that both two-dimensional and three-dimensional rendering is included and not reported separately. To report one of these CTC codes, interpretation of the entire exam (i.e., both intra- and extraluminal evaluation) must take place.

74261 Computed tomographic (CT) colonography, diagnostic, including image post processing; without contrast material.
74262 Computed tomographic (CT) colonography, diagnostic, including image post processing; with contrast material(s) including non-contrast images, if performed (Do not report 74261, 74262 in conjunction with 72192-72194, 74150-74170, 74263, 76376, 76377)
74263 Computed tomographic (CT) colonography, screening, including image post processing (Do not report 74263 in conjunction with 72192-72194, 74150-74170, 74261, 74262, 76376, 76377)

Photodynamic Therapy

An editorial change was made to codes 96570 and 96571 to allow these codes to be reported for photodynamic therapy procedures performed anywhere in the gastrointestinal tract. These codes are “add-ons” to the endoscopy series codes that describe ablation – code 43228 if endoscopy is confined to the esophagus, code 43258 if esophagogastroduodenoscopy is performed or code 43272 for ERCP with ablation (43272) of biliary tree lesions, such as cholangiocarcinoma.

+96570 Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract)

+96571 Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract) (96570, 96571 are to be used in addition to bronchoscopy, endoscopy codes) (Use 96570, 96571 in conjunction with 31641, 43228 as appropriate)

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