Gastroenterology Coding Alert

Bipolar cautery description gets a boot out of 43216 descriptor.

This year, you saw a lot of new inclusions and revisions in esophagoscopy codes. As of January 1, 2015, CPT® has decided to refine the codes introduced earlier and also added a new code to deal with diverticulectomy.

Esophagoscopy Welcomes a Single New Member 43180

Last year, CPT® added new codes in the series from 43191-43196 (Esophagoscopy, rigid, transoral …). This time, CPT® 2015 introduces a new code for rigid esophagoscopy (43180, Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus [eg, Zenker’s diverticulum], with cricopharyngealmyotomy, includes use of telescope or operating microscope and repair, when performed). 

This code will enable gastroenterologists or other specialists to identify the emerging procedure used for non-surgical and non-incisive removal and repair of Zenker’s diverticulum. The procedure is also variously known as endoscopic transoral stapling of Zenker’s diverticula, transoral resection of short segment Zenker’s diverticulum, endoscopic cricopharyngealmyotomy, transoral repair of Zenkers diverticulum, etc.

Minor Descriptor Changes Round Off Esophagoscopy Updates

The other code updates in the esophagoscopy family include descriptor changes. CPT® 2015 has updated the descriptors for codes 43194 (Esophagoscopy, rigid, transoral; with removal of foreign body) and 43215 (Esophagoscopy, flexible, transoral; with removal of foreign body) by including removal of multiple bodies. That effectively means that from next year onward, you will be report the above two codes only once even if the physician removed multiple bodies in the same session. So the new codes will be 43194 (Esophagoscopy, rigid, transoral; with removal of foreign body[s]) and 43215 (Esophagoscopy, flexible, transoral; with removal of foreign body[s])

In recent years, the CPT® Editorial Panel has been replacing the terminology “with or without” in codes with “including, when performed” in an effort to standardize the language and make the code descriptors more accurate. Under this umbrella, the descriptor for code 43197 has been refined with the term “includes” changing to “including.” The code descriptor will now read “Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure).”

However, code 43216 gets a major makeover from 2015 with the provision for “bipolar cautery” being removed from the descriptor. The definition of lesion in the older description also sees a change as CPT® 2015 has added all kinds of lesions, polyps and tumors under one descriptor. The code 43216 (Esophagoscopy, flexible, transoral;  lesion removal by hot forcep or bipolar cauter) gets updated to 43216 (Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps). That means that you will not be able to report this code if your provider has removed lesion(s) by any kind of cauterization.

Stay tuned: You’ve got more CPT® 2015 changes for your gastroenterology practice. Check out the upcoming issues of Gastroenterology Coding Alert for the latest information.