Gastroenterology Coding Alert

From GI anesthesiology to abdominal x-rays, we've got the tips for you.

January and February are behind us, which means chances are strong that your practice has already begun reporting the new codes that CPT^® debuted effective Jan. 1. If you're confused about codes like GI anesthesia or abdominal x-rays, we've got a few quick tips that can help you report these services accurately every time.

Follow These Specs for Anesthesia

As most coders know, CPT^® 2018 tripled the number of codes that describe anesthesia for gastrointestinal endoscopic procedures, and if you've faced any confusion over them, now is a good time to check out the latest expert advice eon how to report these services.

Some coders have been confused by how to classify which anesthesia codes go with each surgical procedure. However, the AMA has cleared up that confusion regarding the following code options:

• 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.

"Codes 00731 and 00732 should be reported for anesthesia for upper GI endoscopic procedures; 00811 and 00812 for anesthesia for lower intestinal endoscopic procedures; and 00813 for anesthesia provided for combined upper and lower GI endoscopic procedures," the AMA said in the Dec. 2017 edition of CPT^® Assistant."

In many cases, the services required to report 00813 involve repositioning the patient when the doctor switches between performing the upper and lower GI endoscopies. However, you cannot collect extra pay for any adjustments made in between the two services, the AMA advises.

"Additional anesthesia work, such as repositioning the patient, responding to physiologic changes when reinserting the scope into a different location, and other nonduplicative work involved in the additional procedure, is included in the combined upper and lower endoscopic code 00813," CPT^® Assistant states.

If a screening colonoscopy becomes diagnostic or therapeutic, (i.e., something abnormal is found and possibly treated/removed), the 00812 code should still be reported since the intent of the procedure was screening, says Glenn D. Littenberg,  MD,  MACP,  FASGE,  AGAF,  a gastroenterologist in Pasadena, California. "If the exam is performed for diagnostic reasons, including positive fecal occult blood, the 00811 code is reported, even if nothing abnormal is found."

Prep for New Payment Amounts for X-Rays

Gastroenterology practices were pleased to see the new codes for abdominal x-rays, and many were curious about the payment amounts that CMS would apply to the codes. Following you'll find the Part B outpatient payment amounts that CMS has designated for these new codes:

• 74018 – Radiologic examination, abdomen; 1 view – pays $27.72
• 74019 – Radiologic examination, abdomen; 2 views – pays $33.84
• 74021 – Radiologic examination, abdomen; 3 or more views – pays $39.60

Remember that if you're only reporting the gastroenterologist's interpretation of a film, you should append modifier 26 (Professional component) to these codes, and payment will be reduced accordingly. Conversely, if you perform the x-ray itself and a radiologist or other clinician from outside your practice performs the interpretation, you'll append modifier TC (Technical component) to the appropriate x-ray code.