Gastroenterology Coding Alert

" CPT 2001 includes 14 new gastrointestinal endoscopy codes and several code revisions. The new code additions primarily reflect current endoscopic ultrasound (EUS) examination procedures, ultrasound-guided intramural or transmural fine needle aspiration (FNA)/biopsy procedures and stent placement procedures in most sections of the gastrointestinal tract. While these codes will be welcomed by gastroenterologists, many questions still surround their appropriate usage.

The new gastrointestinal endoscopy codes go into effect on Jan. 1, 2001, and will concentrate on the following three medical procedures:

endoscopic ultrasound examinations (EUS);

ultrasound-guided intramural or transmural fine needle aspiration (FNA)/biopsy; and

the transendoscopic placement of stents.

Coding EUS and FNA/Biopsy

The new EUS and related EUS FNA/biopsy codes are as follows:

43231 esophagoscopy, rigid or flexible; with endoscopic ultrasound examination

43232 ... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)

43242 upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)

45341 sigmoidoscopy, flexible; with endoscopic ultrasound examination

45342 ... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)

All CPT definitions for these EUS and FNA/biopsy codes contain the phrase fine needle aspiration/biopsy(s). The (s) indicates that this code should be reported once, regardless of the number of fine needle biopsies taken during the session.

Reimbursement May Drop With New Codes

Although gastroenterologists have lobbied a long time for these EUS codes, they may be disappointed with the reimbursement, particularly from Medicare. A radiological supervision and interpretation code cannot be billed with these new EUS codes. A cross-reference appears at the end of each new EUS and EUS FNA/biopsy code that instructs gastroenterologists to not report 76975 [gastrointestinal endoscopic ultrasound, supervision and interpretation] in conjunction with the EUS procedures.

The CPT manual illustrates that the work that goes into the interpretation and supervision of the radiological films is built into the endoscopic ultrasound codes themselves, says Maurits Wiersema, MD, FACP, FACG, a gastroenterologist and associate professor of medicine at the Mayo Clinic in Rochester, Minn., and a member of the American Medical Associations (AMA) CPT editorial advisory panel.

However, that creates a real paradox because gastroenterologists will get paid less for doing an upper gastrointestinal endoscopy (EGD) with an EUS FNA/biopsy under CPT 2001 than they would if they performed an EGD with only an EUS (43259, upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum [...]