Monday, May 11, 2015

General Concepts for all GI Endoscopy Procedures



In recent years, the CPT Editorial Panel has been replacing the terminology “with or without” in codes throughout the CPT book with “including, when performed” in an effort to standardize the language and make the code descriptors more accurate. Previously, all GI endoscopy family base codes contained the language “diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).” In CPT 2014 “with or without” was replaced by “including, when performed” for esophagoscopy, EGD and ERCP. The same terminology reconciliation will be made to ileoscopy, pouchoscopy, flexible sigmoidoscopy, colonoscopy through stoma and colonoscopy in CPT 2015. This represents an editorial change and does not change the way the codes are reported.

The CPT Editorial Panel has also been replacing “bowel” with “intestine” throughout the CPT book. This represents an editorial change and does not change the way the codes are reported.

Placement of stent
Existing lower GI endoscopy codes for placement of endoscopic stents include predilation. The new lower GI endoscopy codes for placement of endoscopic stents now include pre-dilation, post-dilation and guide wire passage, when performed, consistent with the changes made to stent placement codes for upper GI endoscopy procedures. Placement of stent should be reported without a reduced services modifier 52, even if all three components (predilation, post-dilation, guide wire passage) are not erformed during the same session. Separate reporting of predilation, post-dilation or guide wire passage is not appropriate, as these services are now bundled into the code for the placement of the stent.

Control of Bleeding
Previous code descriptors for control of bleeding codes included a list of examples such as injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler and plasma coagulator. The new descriptor for control of bleeding replaces all examples with “any method” throughout all GI endoscopy families. Do not report submucosal injection if the injection was part of the control of bleeding procedure. New language in the section guidelines clarifies that when bleeding occurs as the result of an endoscopic procedure, control of bleeding is not separately reported during the same operative session.

Ablation
New codes for ablation procedures now include pre- and post-dilation and guide wire passage, when performed. Separate reporting of pre- or post-dilation or guide wire passage is no longer appropriate, as these services are bundled into the code for ablation. Ablation procedures are not reported with a reduced services modifier 52 when all three components (pre-dilation, post-dilation or guide wire passage) are not performed during the same session. Separate reporting of pre-dilation, post-dilation or guide wire passage is not appropriate, as these services are now bundled into the code for the ablation.

Endoscopic Mucosal Resection
Endoscopic mucosal resection (EMR) can include injection-assisted, cap-assisted and ligation-assisted techniques. All techniques involve 1) Identification and demarcation of the lesion; 2) Submucosal injection to lift the lesion; and 3) Endoscopic snare resection. Separate reporting of submucosal injection, banding or snare polypectomy is not appropriate, as these services are bundled into the code for EMR. When biopsy is performed on the same lesion as EMR, biopsy is not reported.

Colonoscopy
The definition of a colonoscopy examination is now specifically described in CPT as the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.

When performing a diagnostic or screening procedure on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report 45378 (colonoscopy) or 44388 (colonoscopy through stoma) with modifier 53 and provide appropriate documentation.

If a therapeutic examination colonoscopy is performed and does not reach the cecum or colon-small intestine anastomosis, report the appropriate therapeutic colonoscopy code with modifier 52 and provide appropriate documentation.

New codes for the colonoscopy family include endoscopic mucosal resection (EMR), band ligation and decompression for pathologic distention. Revised codes address appropriate reporting of ablation and stent placement.

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