Gastroenterology Coding Alert

Fortunately, the latest edition of CPT^® isn’t as earth-shattering as last year’s.

The changes that impacted the outpatient E/M code set at the beginning of 2021 were nearly overwhelming to many GI coders — but luckily, the updates for 2022 aren’t anywhere near as comprehensive. Instead, you’ll just have to make a few adjustments so you can be up to date with the latest codes and descriptors.

Among the most relevant changes for GI practices are a tweak to the descriptor for 99211 and a new code for POEM. Read on to get some detailed knowledge on these respective changes so you can be prepared before the calendar turns to 2022.

Check This E/M Update

You’ll recall that CPT^® 2021 removed the time component from the 99211 descriptor, which previously said, “Typically, 5 minutes are spent performing or supervising these services.” For 2022, the AMA has further truncated the code descriptor, which now reads, “Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.” What’s missing is the previous verbiage stating, “usually, the presenting problem(s) are minimal.”

In the 2021 E/M guidelines, the AMA released its definition of “minimal,” noting that a minimal problem was one “that may not require the presence of the physician or other qualified health care professional, but the service is provided under the physician’s or other qualified health care professional’s supervision.”

Therefore, it’s possible that the AMA removed the “presenting problem(s) are minimal” terminology from the 99211 descriptor because it’s redundant, considering that 99211 is already meant to describe a service defined similarly to how the AMA defines a minimal problem.

Consider New POEM Code

When it comes to the surgical codes, the 2022 updates for gastroenterology coders are somewhat tame, other than a new code for POEM, as follows:

• 43497 (Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy (POEM))

During the POEM procedure, performed to treat achalasia, physicians use a scope to make an incision in the mid-esophagus and then dissect through the submucosal space and dissect muscle fibers of the lower esophageal sphincter muscle, says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a gastroenterologist and former CPT® Editorial Panel member in Pasadena, California.

“This helps relieve the problem of severe dysphagia for food and chest pain that achalasia causes,” he says. “The incision is closed sometimes with clips or endoscopic suturing, and the procedure is similar to what was performed as a ‘Heller myotomy’ by surgeons before the endoscopy technique was developed.” Gastroenterology coders currently report POEM with unlisted code 43499 (Unlisted procedure, esophagus).

Stay tuned as the AMA releases more details about the new, revised, and deleted codes for 2022 — Gastroenterology Coding Alert will continue to report on the updates as more information is released.