Gastroenterology Coding Alert

G codes for Medicare infusions add another coding twist This year, reporting your gastroenterologist's Crohn's disease services may be even more intricate than before - particularly if your office uses Remicade (Infliximab) to treat patients with the condition.

Why? Medicare's new set of G codes for infusion, injection and hydration directly affects coding for Remicade infusions. And you'll have to remember acceptable diagnosis codes for Crohn's treatment and reporting drug supplies.

Join us for some expert input on coding Crohn's patients from the first office visit through Remicade infusion. We'll also explain how Remicade reporting will be different for your Medicare patients in 2005. Consult Typically Leads to Crohn's Diagnosis A Crohn's patient's initial encounter with a gastroenterologist is typically a consultation requested by the patient's primary-care physician (PCP). The PCP may recognize Crohn's symptoms based on a gastroenterological malady, which spurs the gastroenterologist's involvement, says Lois Curtis, CPC, of Gastroenterology Associates in Evansville, Ind.

When a patient reports to your gastroenterologist for this consultation, the patient does not have a Crohn's diagnosis at this point. Even though the PCP suspects Crohn's, the gastroenterologist must perform additional tests to confirm the condition, Curtis says.

Example: A PCP refers a patient to your gastroenterologist to check for Crohn's disease. The patient has a history of chronic abdominal pain in the lower right quadrant and diarrhea. Based on the findings of a level-two consultation service, the gastroenterologist schedules the patient for a colonoscopy.

Two days later, the gastroenterologist performs a colonoscopy with biopsy to examine the patient's terminal ileum and mucosa.

On the claim, you should:
   report 99242 (Office consultation for a new or established patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and straightforward medical decision making) for the consultation
   report CPT 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) for the colonoscopy
   attach ICD-9 codes 789.03 (Abdominal pain; right lower quadrant) and 787.91 (Diarrhea) to 99242 and 45380 to account for the patient's stomach pain and diarrhea.   Other Symptoms May Also Indicate Crohn's The patient in the above example had stomach pain and diarrhea, but the doctor may discover other symptoms of Crohn's disease in a patient, says Bonnie VanderWerf of Marin Gastroenterology in Greenbrae, Calif.

Crohn's patients whom her gastroenterologist treats may also have the following, VanderWerf says:   benign neoplasm of the colon (211.3)
   pernicious anemia (281.0)
   regional enteritis (555.x)
   ulcerative colitis (556.x)
   intestinal obstruction without mention of hernia (560.x)
   nausea and vomiting (787.0x).

Patients with any of these symptoms are candidates for further diagnostic testing (such as a colonoscopy with biopsy) to check for Crohn's, VanderWerf says.

After the testing, the gastroenterologist will "generally wait for the pathology to give a definitive diagnosis of Crohn's disease; you do not want to [...]