Gastroenterology Coding Alert

Watch out for per-day restrictions when reporting starred (*) G codes

Gastroenterology offices will need to remember a number of new G codes when reporting injections and infusions to Medicare in 2005, because using the old codes will result in a brisk Medicare denial.

Heads up: Coders should also expect reimbursement from only one "initial" code per day (denoted with a * in the table), according to Medicare. When your gastro performs multiple initial per-day codes, choose the best code to describe the key service.

For example, let's say a patient reports for a four-hour Remicade infusion, as well as an IV push Benedryl injection. On the Medicare claim, you should report G0345 for the first hour of infusion time; G0346 x 3 for the subsequent infusion time; and G0354 for the Benedryl injection. Do not report G0353 for the Benedryl injection, because G0345 and G0353 are both "initial" codes, and you can only report one initial code per day.
  
Here is a list of the new HCPCS codes for Medicare, and the existing procedure codes that correspond (where applicable). Gastro coders should report these new G codes in place of the CPT codes for Medicare patients. For non-Medicare patients, report the same codes you would have in 2004. (Note: For more information about how these new G codes will affect your gastroenterology coding, see "Stick To New G Codes When Reporting Infusions, Injections To Medicare").