Gastroenterology Coding Alert

The answers to your endoscopy coding problems are finally here: New 2003 CPT codes clarify how to bill properly for several common gastrointestinal procedures including lower gastrointestinal dilations and other endoscopies that include injections

The proposed changes to the CPT manual will go into effect on Jan. 1, 2003. New Codes Allow Proper Reimbursement for Submucosal Injections You will no longer be faced with denials of claims for injections performed during endoscopies. Until now, injection codes (90780-90784) were bundled into many of the gastrointestinal endoscopy procedures. According to Linda Parks, MA, CPC, CCP, lead coder at Atlanta Gastroenterology Associates, in the past "all of the procedures that now have new codes were filed either with an unlisted-procedure code or with the base code and a -22 modifier (Unusual procedural services) appended." Physicians always sent a copy of the operative notes and a letter stating the medical need and a comparison of the procedure. Payments were usually delayed, and the reimbursement was poor. Hopefully, the new codes will end any delay and stop physicians from having to send extra paperwork.

Endoscopies that require submucosal injections are usually more difficult and more time-consuming than other endoscopies. The new codes were needed to properly describe in CPT nomenclature the additional time, extra work, and risk to the patient that come with the use of submucosal injections. After Jan. 1, you will be reimbursed properly for these more in-depth procedures. Four new codes are related to endoscopies with injections:

43201 Esophagoscopy, rigid or flexible; with directed submucosal injection(s), any substance, with cross-reference (For injection sclerosis of esophageal varices, use 43204)
43236 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection(s), any substance, with cross-reference (For injection sclerosis of esophageal and/or gastric varices, use 42343)
45335 Sigmoidoscopy, flexible; with directed submucosal injections(s), any substance
45381 Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance. Report these codes only once, regardless of the number of injections given. Examples of substances that can be used are India ink, botulinum toxin, saline and corticosteroid solutions.

You will need to use these new codes under a variety of circumstances. Joel Brill, MD, a gastroenterologist in Phoenix who is the American Gastroenterological Association representative to the CPT Editorial Advisory Committee and the RBRVS Update Committee, describes several scenarios in which these codes will be used. Code 43201: A 75-year-old man with a history of radiation therapy for lung cancer comes to the office because he has difficulty swallowing. After the physician administers conscious sedation, the endoscope is inserted and an esophagoscopy is performed confirming a tight stricture at 31 cm. The endoscope cannot be passed [...]