Gastroenterology Coding Alert

Be ready for removal of conscious sedation from 43235, 43260, and many more changes…

The AMA has released the final version of CPT® 2017, and you have a lot to learn before the updates take effect on Jan. 1. With an overhaul of 150 gastroenterology codes on the horizon, you’ll need to start your preparations right away.

Expect to Start Reporting Moderate Sedation Jan. 1

The biggest overall change you can expect to see in CPT^®  2017 is the removal of conscious (moderate) sedation from hundreds of codes “This will have a big impact on physicians who do scopes frequently,” says Lisa Center, CPC, Physician Practice Manager, Via Christi Hospital Pittsburg, Inc. Pittsburg, KS.

Remember: In CPT^® 2016, more than 400 codes, listed in CPT^® Appendix G, have the circle-with-a-center-dot symbol indicating that you should not report sedation separately. That’s because the marked code includes moderate sedation administered by the same provider performing the procedure.

However, with a single sweep, all 400 codes will no longer include moderate sedation services. That means you will have to report moderate sedation in addition to the basic procedure code in 2017. Prepare now so your practice is ready to properly document and code for moderate sedation starting on Jan. 1.

There is a great “concern over removal of moderate sedation from endoscopy procedures because of reduction in reimbursement,” says Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president, Healthcare Resource Management, Inc. Spring Lake, NJ.

How the change came about: “The landscape for ambulatory endoscopy procedures has changed over the past decade,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel. “Gastroenterologists have recognized benefits in using Propofol sedation administered by an anesthetist compared to the benzodiazepine and narcotic combination sedation method administered by the gastroenterologist-nurse team. More than half of ambulatory procedures are now performed with Propofol sedation and the change in the coding rules reflects the change in practice. The anesthetist is permitted to submit a claim for sedation administration services but the prior procedure definition prevents the gastroenterologist from submitting a separate claim for the sedation administration.”

Tip: The 2017 Medicare Physician Fee Schedule proposed rule indicates Medicare will be reducing RVUs for Appendix G codes because moderate sedation reimbursement will no longer be included in those codes (www.gpo.gov/fdsys/pkg/FR-2016-07-15/pdf/2016-16097.pdf).

Remove Conscious Sedation from Endoscopy Codes

Endoscopy codes that have been revised to remove the conscious sedation symbol include:

• 43200 to 43233 (Esophagoscopy, flexible, transoral; …) – 19 codes
• 43235 to 43259 (Esophagogastroduodenoscopy flexible, transoral;…) – 23 codes
• 43260 to 43270 (Endoscopic retrograde cholangiopancreatography (ERCP);…) – seven codes
• 44360 to 44379 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum;…) – 14 codes
• 44380 to 44384 (Ileoscopy, through stoma;…) – four codes,
• 44385 to 44386 (Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]);…) – two codes,
• 44388 to 44500 (Colonoscopy through stoma;…) – 15 codes
• 45378 to 45398 (Colonoscopy flexible;…) – nine codes

Note These Changes for ECRP, Proctosigmoidoscopy and More

Six codes for reporting Endoscopic Retrograde Cholangiopancreatography (ERCP) 43260- 43265 (Endoscopic retrograde cholangiopancreatography [ERCP];…) as well as the proctosigmoidoscopy codes 45393 to 45338 will also undergo removal of moderate sedation in 2017.

Plus: Expect removal of conscious sedation from 49405 to 49407 (Image-guided fluid collection drainage by catheter [eg, abscess, hematoma, seroma, lymphocele, cyst]…) and the following procedure codes relating to biliary duct.

• 47533, 47534 (Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance [eg, ultrasound and/or fluoroscopy], and all associated radiological supervision and interpretation…)
• 47535 (Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance [eg, fluoroscopy], and all associated radiological supervision and interpretation)
• 47536 (Exchange of biliary drainage catheter [eg, external, internal-external, or conversion of internal-external to external only], percutaneous, including diagnostic cholangiography when performed, imaging guidance [eg, fluoroscopy], and all associated radiological supervision and interpretation)
• 47537 (Removal of biliary drainage catheter, percutaneous, requiring fluoro­scopic guidance [eg, with concurrent indwelling biliary stents], including diagnostic cholangiography when performed, imaging guidance [eg, fluoroscopy], and all associated radiological supervision and interpretation)
• 47538-40 (Placement of stent[s] into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance [eg, fluoroscopy and/or ultrasound], balloon dilation, catheter exchange[s] and catheter removal[s] when performed, and all associated radiological supervision and interpretation, each stent…)
• 47541 (Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure [eg, rendezvous procedure], percutaneous, including diagnostic cholangiography when performed, imaging guidance [eg, ultrasound and/or fluoroscopy], and all associated radiological supervision and interpretation, new access)
• 47542 (Balloon dilation of biliary duct[s] or of ampulla [sphincteroplasty], percutaneous, including imaging guidance [eg, fluoroscopy], and all associated radiological supervision and interpretation, each duct [List separately in addition to code for primary procedure])
• 47543 (Endoluminal biopsy[ies] of biliary tree, percutaneous, any method[s] [eg, brush, forceps, and/or needle], including imaging guidance [eg, fluoroscopy], and all associated radiological supervision and interpre­tation, single or multiple [List separately in addition to code for primary procedure])
• 47544 (Removal of calculi/debris from biliary duct[s] and/or gallbladder, percutaneous, including destruction of calculi by any method [eg, mechanical, electrohydraulic, lithotripsy] when performed, imaging guidance [eg, fluoroscopy], and all associated radiological supervision and interpretation [List separately in addition to code for primary procedure).

Final takeaway: “The change in coding for these procedures is associated with a planned small change in valuation of the total physician work,” says Weinstein. “Removal of the included work of conscious sedation will lower the total procedure RVUs by 0.1 units. This will result in decreased payments of about $4 for the procedure code. If the gastroenterologist administers the sedation then he will submit the new 2017 moderate sedation code along with the procedure code.”

Editor’s note: Stay tuned to learn more on how to survive this change.