Thursday, May 26, 2016

Gastroenterology CPT code list

Code Description Comments

31525, 31575 Diagnostic laryngoscopy
43215 Esophagoscopy for removal of foreign body
43220 Esophageal endoscopy dilation
43257 (Stretta procedure) Upper gastrointestinal endoscopy including esophagus, stomach, and either duodenum and/or jejunum; diagnostic, w/delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of GERD Not reimbursed
43312 Esophagoplasty, (plastic repair or reconstruction) thoracic
43621 Gastrectomy, total; with Roux-en-Y reconstruction
43633 Gastrectomy, partial, distal with Roux-en-Y reconstruction
43644 Laparoscopy, surgical, gastric restrictive procedure; w/gastric bypass
and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)
43645 Laparoscopy, surgical, gastric restrictive procedure; w/gastric
bypass and small intestine reconstruction to limit absorption
43647–43648 Laparoscopy, surgical: gastric neurostimulator procedures Will only be reimbursed when billed with the following diagnosis codes:
43770–43774 Laparoscopic, gastric restrictive procedures
43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie; sleeve gastrectomy) Procedure is reimbursed when medically
necessary with prior authorization
43830 Gastrostomy, without construction of gastric tube Not reimbursed when billed with any major abdominal procedure
43842 Gastric restrictive procedure, w/o gastric bypass, vertical-banded gastroplasty Not reimbursed as of 3/24/16
43843 Gastric restrictive procedure, w/o gastric bypass, other than vertical- banded gastroplasty 43845 Gastric restrictive procedure w/ partial gastrectomy, pylorusreserving duodenoileostomy and ileoileostomy to limit absorption (biliopancreatic diversion with duodenal switch)
43846 Gastric restrictive procedure, w/gastric bypass; Roux-en-Y  gastroenterostomy
43881-43882 Gastric neurostimulator, procedures open Will only be reimbursed when billed with the following diagnosis codes:
ICD-9 Covered Indications 536.3 ICD-10 Covered Indications
43886–43888 Gastric restrictive procedures
45317 Proctosigmoidoscopy with control of bleeding
74261,74262 CT colonography, diagnostic, including image postprocessing; with and without contrast Prior authorization is required
74263 Screening virtual colonoscopy Not reimbursed
91110 Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus through ileum, with physician interpretation and report Will only be reimbursed when billed with the following diagnosis codes:
ICD-9 Covered Indications
209.00–209.03, 209.40–209.43, 211.2, 280.0, 280.1, 280.8, 280.9, 555.0, 555.1, 555.2, 555.9, 578.0, 578.1, 578.9, 579.0, 759.6 ICD-10 Covered Indications
91111 Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus, with physician interpretation and report Not reimbursed
91112 Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule with interpretation and report Not reimbursed as of 3/1/16
91132, 91133 Electrogastrography, diagnostic, transcutaneous; with or without provocative testing Not reimbursed
91299 Unlisted diagnostic gastroenterology procedure Not reimbursed when billed for SmartPill GI Monitoring System
95980–95982 Electronic analysis of implanted neurostimulator pulse generator system ICD-9 Covered Indications 536.3 ICD-10 Covered Indications
99026, 99027 Hospital-mandated physician on-call services
Not reimbursed
99143–99145 Moderate sedation services

1 comment:

Most read colonoscopy CPT codes