Wednesday, February 25, 2015

Crosswalking Certain CY 2014 Lower GI Endoscopy CPT Codes to 2015 HCPCS G-Codes for Medicare During CY 2015

Important Correction in 2015 CPT coding Update in GI Codes

Below is the correct version of the Decision Tree. When coding a therapeutic procedure to the cecum, bill the appropriate colonoscopy CPT code with NO modifier. Please note that the “Diagnostic Procedure” decision node can include screening or diagnostic procedures.



Medicare Payment for Colonoscopy Procedures
In the Medicare Physician Fee Schedule (MPFS) final rule for 2015, CMS finalized a new, more transparent rate setting process. CMS will propose values for the vast majority of new, revised and potentially misvalued codes and consider public comments before establishing final values for the codes. CY 2015 will be a transition year, when updates to the colonoscopy and other lower GI endoscopy codes will be included in the CY 2016 proposed rule.

Beginning with rulemaking for CY 2017, CMS will publish the proposed values for the following calendar year during June–July, providing interested parties the opportunity to submit comments before the values are finalized. This will require CMS to address comments when the final rule is published in November.

Use of Temporary G-codes for Lower GI Endoscopy for Medicare
To implement this new initiative on transparency, CMS finalized the use of temporary G-codes to facilitate continued payment for new or modified CPT codes that do not have the benefit, due to the timing of the AMA RUC process, of first being published in the proposed rule.

Since the lower GI endoscopy CPT code set is changing for CY 2015, including the deletion of some of the CY 2014 codes, CMS is creating G-codes for 10 lower GI endoscopy services to allow practitioners to report services provided to Medicare beneficiaries in CY 2015 the same way they did in CY 2014.

For existing procedures that have new CPT code assignments in CPT 2015, CMS requires physicians to report the G-code instead of the corresponding 2015 CPT code.

Crosswalking Certain CY 2014 Lower GI Endoscopy CPT Codes to 2015 HCPCS G-Codes for Medicare During CY 2015

CY 2014 CPT Code CY 2015 HCPCS Code Long Description
44383 G6018 Ileoscopy, through stoma; with transedoscopic stent placement (includes predilation)
44393 G6019 Colonoscopy through stoma; with ablation of tumor(s), polyp(s) or other lesion(s), not amenable to removal by hot biopsy forceps, biopolar cautery or snare techinique
44397 G6020 Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)
44799 G6021 Unlisted procedure, intestine
45339 G6022 Sigmoidoscopy, flexible; with ablation of tumor(s), poly(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45345 G6023 Sigmoidoscopy, flexible; with transendoscopic stent
placement (includes predilation)
45383 G6024 Colonoscopy, flexible, proximal to splenic flexure; with
ablation of tumor(s), polyp(s) or other lesion(s) not
amenable to removal by hot biopsy forceps, bipolar
cautery or snare technique
45387 G06025 Colonoscopy, flexible, proximal to splenic flexure; with
transendoscopic stent placement (includes predilation)
0226T G6027 Anoscopy, high resolution (HRA) (with magnification
and chemical agent enhancement); diagnostic,
including collection of specimen(s) by brushing or
washing when performed
0027T G6028 Anoscopy, high resolution (HRA) (with magnification
and chemica

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