Gastroenterology Coding Alert

Get ready for new changes to evaluation and management codes, too.

The CPT® Editorial Committee has already started making preparations for the coming year by issuing the list of proposals for the year 2013, including approval for a new code for fecal bacteriotherapy.

Reminder: Although the editorial committee has posted these changes, it is not essential that all these changes will be taken forward in CPT® 2013. As the editorial notes indicate, "Codes are not assigned, nor exact wording finalized, until just prior to publication."

Don't Reach Out For Unlisted Code For Fecal Bacteriotherapy in 2013

Your gastroenterologist might be resorting to performing a new procedure called fecal bacteriotherapy (also known by other names such as stool transplant, fecal transplant, fecal microbiota transplant, and human probiotic infusion) to combat virulent strains of Clostridium difficile infections not responding to antibiotics or other forms of treatment. In this procedure, your gastroenterologist will transplant a healthy individual's fecal flora into the person suffering from C. difficile infection using a colonoscope, a nasoduodenal tube or a nasogastric tube.

Until now, you would have to report the procedure using an unlisted code (44799, Unlisted procedure, intestine) and the colonoscopy using the appropriate code (such as 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]).

If the proposal of the CPT® Editorial Committee gets approval, you will be able to report fecal bacteriotherapy using a newly introduced code (447XX) to report the physician work provided for donor assessment and oversight of fecal microbiota preparation instead of using the unlisted code 44799.

EGD Simple Primary Examination Gets Deleted

If the recommendations of the CPT® Editorial Committee comes through, the code for simple primary examination using a flexible endoscope (43234, Upper gastrointestinal endoscopy, simple primary examination [e.g., with small diameter flexible endoscope] [separate procedure]) might get deleted. This deletion was due to the fact that this procedure is hardly being performed by gastroenterologists these days, as they opt for more comprehensive diagnostic procedures, such as 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]).

So if your gastroenterologist performs this procedure, brace yourself for this change, as 43234 might face the axe in 2013.

Prep for Possible Vaccine Code Updates

The trend in overhauling vaccine codes continues in 2013, as updated vaccines spark CPT® changes. Look for the following changes to vaccine codes in 2013:

• A new code 9074XX is proposed to be introduced to report an adult 2 dose Hepatitis B vaccine and the existing code 90746 (Hepatitis B vaccine, adult dosage, for intramuscular use) will be revised to specify use for 3 dose product formulation.
• The existing descriptors to influenza vaccines codes 90655-90658 (Influenza virus vaccine, split virus...) might include the term "trivalent" to help distinguish these vaccines from the newest quadrivalent influenza vaccines.
• The descriptor to 90660 ((Influenza virus vaccine, live, for intranasal use) might also get altered to incorporate the term "trivalent" while a new code range 906XX might be created to include intranasal quadrivalent influenza vaccines.
• The new code series (906XX) proposed to be introduced might include a code to report an adjuvant influenza vaccine.
• Code 90718 (Tetanus and diphtheria toxoids [Td] adsorbed when administered to individuals 7 years or older, for intramuscular use) might get scrapped while 90714 (Tetanus and diphtheria toxoids [Td] adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use) might have to be used universally to report all the tetanus and diphtheria products.

"Vaccine code specification requires increased accuracy in reporting, but also allows for a more cost-effective system in which the reimbursement can accurately reflect the individual costs corresponding to the various codes," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine in Philadelphia.

Check These Proposed Changes to E/M Services

If the proposed revisions to CPT® 2013 come into effect, you might see a major overhaul to the way you report E/M services performed by your gastroenterologist. Some of these proposed changes include:

• Revision to the guidelines of the evaluation and management subsection of codes including a) hospital observation services/ initial observation care/ new or established patients; b) hospital inpatient services; initial hospital care/new or established patients; c) inpatient consultations/new or established patient; d) Prolonged services/prolonged physician service without direct (face-to-face) patient contact; and e) preventive medicine services/counseling risk factor reduction and behavior change intervention.
• Revisions to the CPT® guidelines in the Medicine/Vaccine/Toxoid Administration subsection to include a specific listing of applicable evaluation and management CPT® codes.

Editor's note: Look for more 2013 CPT® updates in future issues of Gastroenterology Coding Alert.