Gastroenterology Coding Alert

Plus: Look for revisions to total esophagectomy codes as well.

If you were pleased to find new diagnosis codes that took effect with the 2018 edition of ICD-10, you're sure to be even more intrigued by the latest CPT^® codes, which will go into service on Jan. 1. The following breakdown can help you prepare for the changes that the AMA has set forth for gastroenterology coders when the calendar turns to 2018.

1. Check Out New Anesthesia Codes

CPT^® 2018 triples the number of anesthesia codes for gastrointestinal endoscopic procedures, with the following new codes debuting effective Jan. 1:

• 00731: Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified
• 00732: Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)
• 00811: Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
• 00812: Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy
• 00813: Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum

These six codes replace the two that CPT^® currently has in it. CPT^® will delete codes 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) and 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) effective Jan. 1.

2. CPT^® Unveils Laparoscopic Esophagectomy Codes

CPT^® will include three codes that describe laparopscpic esophagectomies, replacing the need to bill these services with unlisted codes. The new codes, which will primarily be used by surgeons, are as follows:

• 43286: Esophagectomy, total or near total, with laparoscopic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy,
• with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, laparoscopic transhiatal esophagectomy)
• 43287: Esophagectomy, distal two-thirds, with laparoscopic mobili­zation of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic esophagogastrostomy (ie, laparoscopic thoracoscopic esophagectomy, Ivor Lewis esophagectomy)
• 43288: Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, thoracoscopic, laparoscopic and cervical incision esophagectomy, McKeown esophagectomy, tri-incisional esophagectomy)

CPT^® will also debut a new surgical laparoscopy code with the introduction of 38573 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy[ies], omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy[ies], when performed) effective Jan. 1.

3. Updates to Abdominal X-Ray Codes

CPT^® 2018 will streamline the abdominal x-rays, with the following three new codes debuting in this section:

• 74018 (Radiologic examination, abdomen; 1 view)
• 74019 (Radiologic examination, abdomen; 2 views)
• 74021 (Radiologic examination, abdomen; 3 or more views)

These new codes will replace the previous abdominal x-ray codes 74000-74020 which will be deleted in the New Year. The updated code list suggests that coders will no longer have to worry about which specific views were taken (such as decubitus, anteroposterior, etc.) and instead will just focus on how many views were taken in total.

4. Esophagectomy Codes See Revisions

You'll find the verbiage adjusted for CPT^® code 43112 effective Jan. 1, with the following changes slated for the new edition of the CPT® manual:

• 43112 Existing Descriptor: Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty
• 43112 New Descriptor: Total or near total esopha­gectomy, with thoracotomy; with pharyngogas­trostomy or cervical esophagogastrostomy, with or without pyloroplasty (ie, McKeown esophagectomy or tri-incisional esophagectomy)

"For those coders in groups where esophagectomy is done, these nuances are helpful since surgeons may use words like 'McKeown' in their reports, so coders could more easily recognize what procedure was done," said Glenn Littenberg MD, a gastroenterologist in Pasadena, Calif.

5. Subtle Language Change to Observation Codes 99217-99220

You have to look closely to notice, but the preamble to the "Initial Observation Care, New and Established Patient" section of CPT® and the full code descriptors for 99217-99220 have the words "outpatient hospital" inserted before the term "observation status." For example, the passages now read as follows:

"The following codes are used to report the encounter(s) by the supervising physician or other qualified health care professional with the patient when designated as outpatient hospital 'observation status.'"

This appears to indicate observation services are only allowed in the hospital setting, whereas the presumption in the past was that observation was a "status" and not a defined place. That status is now limited to the outpatient hospital setting. This should not be a concern for hospital-based EDs, but it could be a concern for freestanding emergency centers if they are deemed not to be outpatient hospitals.

The place of service for these visits should be outpatient hospital (22), not emergency department (23) or inpatient (24), Littenberg said.

Keep an eye on Gastroenterology Coding Alert as new directives are issued that shed additional light on how to report the new codes for 2018.