Gastroenterology Coding Alert

Check new codes for fecal bacteriotherapy and capsule endoscopy too.

Starting Jan.1, you can benefit from four new codes covering optical endomicroscopy, fecal bacteriotherapy and pressure measurement using capsule endoscopy, eliminating challenges you've had capturing reimbursement for services that you had to previously report using unlisted codes.

Use 43206 and 43252 for Optical Endomicroscopy

A technological advance that your gastroenterologist might have started using is optical endomicroscopy to take high resolution images within optically thick tissue. "Examination of the gastrointestinal tract with this modality has allowed a new approach for the early detection of cancer and dysplasia," says Michael Weinstein, MD, Gastroenterologist at Capital Digestive Care in Washington, D.C., and former representative of the AMA's CPT® Advisory Panel.

Previously, you would have used an unlisted code when your gastroenterologist performed optical endomicroscopy, but thanks to CPT® 2013, you'll have codes to report the service. If your gastroenterologist uses optical endomicroscopy for the esophagus, you can use 43206 (Esophagoscopy, rigid or flexible; with optical endomicroscopy) to report this service. When your gastroenterologist uses optical endomicroscopy during an EGD, you can report the procedure using 43252 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with optical endomicroscopy).

Example: Your gastroenterologist performs an esophagoscopy to assess a patient with symptoms of an obstruction of the esophagus. During the esophagoscopy, your gastroenterologist sees an area of the esophagus with some changes to its appearance. To enable him to visualize the areas within the tissue, he decides to use optical endomicroscopy and takes high resolution images of the suspect area.

Since your gastroenterologist only viewed the esophagus and not the rest of the gastrointestinal tract, you will have to report the optical endomicroscopy that he performed using 43206.

Add 44705 to Your Coding Arsenal

"We had previously covered that in 2013 we will see an end to your reporting fecal bacteriotherapy with an unlisted code." You can now update your list of codes with a code for reporting fecal bacteriotherapy, also known as a fecal intestinal transplant (FIT), when your gastroenterologist performs it. So, if your gastroenterologist performs a stool transplant, you will report part of this service with 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen).

In addition to the preparation of the donor specimen (reported using 44705), you will have to use the appropriate code for the instillation of the specimen in the gut. Depending on choice, your gastroenterologist might perform a colonoscopy, EGD, rectal enema or a nasogastric tube to instill the specimen. For example, if your gastroenterologist uses an EGD to instill the specimen, you should report 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]) along with 44705 for the preparation of the specimen.

Example: Your gastroenterologist decides to perform stool transplant on a patient suffering from C. difficile infection not responding to antibiotic treatment and other forms of treatment. He decides to use a sample from the patient's spouse for the transplant. He orders a thorough assessment of the stool sample to check for communicable diseases and other parasitic infections. He then prepares a sample for instilling in the patient's gut.

Your gastroenterologist then performs a colonoscopy to instill the stool sample. You will report the services using 44705 for the preparation and assessment of the stool sample and 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]) for the colonoscopy he performed to place the stool sample in the patient's gut.

Note That Gastrointestinal Transit Becomes Listed

If you were previously reporting gastrointestinal transit and pressure measurement with a swallowed capsule device using the Category III code 0242T (Gastrointestinal tract transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report), starting Jan.1, you can shift your reporting for this procedure when your gastroenterologist performs it using a listed CPT® code.

Beginning in January, you will report a gastrointestinal tract transit and pressure measurement with a telemetry capsule using 91112 (Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report). If you aren't familiar with this new technology, the device is also known as a "Smartpill" and you can learn about the technology at www.smartpillcorp.com.

"The new code has yet to be valued by the Relative Value Update Committee (RUC) but should be sufficient to cover the cost of the technical and professional component of the procedure," says Weinstein. "The permanent CPT® code should eliminate most of the problems providers have had with third party insurance coverage determinations."

Observe Verbiage Tweaks to Other Capsule Endoscopy Codes

In addition to listing gastrointestinal tract transit and pressure measurements, update your coding to include other capsule endoscopy codes, 91110 and 91112, which have a descriptor change. The new descriptor will delete the word "physician" from both these codes.

The changes to the codes are indicated with the strikethroughs (indicating deleted text) as follows:

• 91110 (Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus through ileum, with physician interpretation and report)
• 91111 (Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus with physician interpretation and report)

Impact: Although this change might not mean much in terms of improving any reimbursement, the adjustment allows more qualified professionals to provide an interpretation and report for these tests.