Gastroenterology Coding Alert

Medicare reform legislation will increase conversion factor by 1.5 percent Right around Thanksgiving, Congress presented gastroenterologists a gift they could be thankful for in the coming years. Preventing the programmed 4.5 percent conversion-factor decrease scheduled for 2004, Congress announced an increase at the 11th hour, raising the conversion factor by 1.5 percent for 2004 and 2005.
 
The conversion factor will be increased from 36.7856 to about 37.3373. At press time, CMS had not released the exact numbers. This increase is the byproduct of the passage of the Medicare Prescription Drug and Improvement Act, which Congress approved on Nov. 25. Gastro-Specific Procedures Linda Parks, MA, CPC, CMC, CCP, of GI Diagnostics Endoscopy Center in Marietta, Ga., estimates that among the gastroenterology-specific procedures on the new Fee Schedule, 36 showed an increase in RVUs, 19 showed a decrease, and three stayed the same.
 
The following chart lists some sample RVU increases and decreases that will affect gastroenterology practices. (Information comes from the "Fully Implemented Facility Total" category on the CMS Physician Fee Schedule Web page.): RVU Increases for 2004 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)
2003 RVU: 3.58, 2004: 3.62

43236 - ... with directed submucosal injection(s) any substance 2003 RVU: 4.32, 2004: 4.34

43239 - ... with biopsy, single or multiple 2003 RVU: 4.24, 2004: 4.27

43258 - ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
2003 RVU: 6.62, 2004: 6.64

45330 - Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
2003 RVU: 1.53, 2004: 1.54

45331 - ... with biopsy, single or multiple
2003 RVU: 1.75, 2004: 1.86 RVU Decreases for 2004 43260 - Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 2003 RVU: 8.67, 2004: 8.58

43261 - ... with biopsy, single or multiple
2003 RVU: 9.11, 2004: 9.02 45341 - Sigmoidoscopy, flexible; with endoscopic ultrasound examination 2003 RVU: 4.17, 2004: 3.97

45342 - ... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/
biopsy(s) 2003 RVU: 6.10, 2004: 5.94

45378 - Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
2003 RVU: 5.62, 2004: 5.52

45379 - ... with removal of foreign body
2003 RVU: 7.02, 2004: 6.84  

CPT 45380 - ... with biopsy, single or multiple
2003 RVU: 6.65, 2004: 6.46

45383 - ... with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by [...]