Gastroenterology Coding Alert

Look for both new, revised codes effective Jan. 1.

Ready for a new hemorrhoidectomy code — as well as big changes to your radiology coding processes? CPT^® 2020 delivers, offering a slew of updates that will prompt you to scrutinize how you’re reporting your services.

As gastroenterology coders look forward to 2020, there are 394 total code changes on the horizon, many of which will affect your practice. With 248 new codes, 75 revisions, and 71 deletions on deck for 2020, it’s a good time to review the codes that will be most relevant to your GI office and prepare now. Read on for the highlights.

Check Out New Hemorrhoidectomy Code

If your GI physician performs hemorrhoidectomies, you’ll want to take note of one new code and two revised descriptors in this category. First, CPT^® 2020 debuts a new code that gives you an option if you perform transanal dearterialization of two or more hemorrhoid columns or groups:

• 46948 (Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed)

Note that this new code does include ultrasound guidance, and that you should not separately report any codes to describe mucopexy if you perform it, because that’s included for the payment for 46948. In other hemorrhoidectomy updates, CPT^® will revise the following codes, with added verbiage for 2020 bolded below:

• 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group; without imaging guidance)
• 46946 (Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups; without imaging guidance)

This change makes it clear that if your physician does use imaging guidance, you can either report it separately or select a more appropriate code for the service, since payment for these two codes won’t include reimbursement for imaging guidance.

Prep Now for Radiology Changes

In addition, CPT^® is revising a large swath of radiology codes that impact gastroenterologists. As most GI practices are aware, you currently report 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest) for complete abdominal X-rays. In 2020, the descriptor will change to specify that the code requires “two or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest.”

You’ll also find updates to the following descriptors, with new verbiage bolded:

• Pharynx/cervical esophagus code 74210 (new descriptor Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study) and swallowing study code 74230 (new descriptor Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study) have added verbiage to demonstrate that these are contrast studies and the codes include any scout neck radiographs and delayed images performed in conjunction with the studies.
• Esophagus code 74220 (Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study) adds scout chest radiographs and delayed images. This code will be a single-contrast study, making room for new double-contrast study code 74221 (Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study).
• Upper GI code 74240 (Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study) continues to apply to a single-contrast study, but the descriptor now specifies that it includes scout abdominal radiographs.

To make room for these changes, CPT^®  2020 deletes several radiology codes (74241, 74245, 74247, 74249) and adds small intestine follow-through code +74248 (Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination)) for use with 74240 and 74246 (Radiological examination, gastrointestinal tract, upper, including scout abdominal radiographs and delayed image(s), when performed, double contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered).

You’ll find similar changes in the small intestine exams (74250-74251) and the colon codes (74270-74280) as the CPT^® Panel aims to clarify any questions you may have about coding these radiology codes by expanding out the descriptors.

Say Goodbye to 99444

You’ll find that any digital or e-visit E/M services will be coded quite differently than in the past, with CPT^® now deleting 99444 (Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network).

In its place, CPT^® will introduce 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes) on January 1.

Like its predecessor, 99421 has some significant restrictions, which stipulate that the service has to be:

• Provided to an established patient (or guardian),
• Provided by a physician or other qualified health care professional (QHP), and
• Unrelated to an E/M service provided within the previous seven days.

This means that any online digital E/M service that results from a previous, or that results in a subsequent, E/M visit is not separately reported, and the online E/M service is incorporated into the related E/M visit.

In addition, CPT^® has placed a seven-day cumulative time limitation on 99421 and made the code time-dependent. You will be able to use 99421 if your provider spends between five and 10 minutes on any asynchronous communications with the patient in that time; you will also be able to report longer time increments with 99422 (… 11-20 minutes) or 99423 (… 21 or more minutes).

Time Changes Hit 98970 Series

You’ll also say goodbye to code 98969 (Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network) effective January 1.

In its place, you’ll be able to use three new time-based codes to report the same, asynchronous online services to your patients:

• 98970 (Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes)
• 98971 (… 11-20 minutes)
• 98972 (… 21 or more minutes).

“With the advance of new technologies for e-visits and health monitoring, many patients are realizing the best access point for physician care is once again their home,” said AMA President Patrice A. Harris, MD in a statement about the new changes. “The new CPT^® codes will promote the integration of these home-based services that can be a significant part of a digital solution for expanding access to health care, preventing and managing chronic disease, and overcoming geographic and socioeconomic barriers to care.”