Gastroenterology Coding Alert

There are several instances in which a coder may find these CPT additions handy, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel.

45391 explained: "A gastroenterologist will occasionally encounter an unusual finding during a colonoscopy, where there is a mass suspected under the surface of the intestine. These lesions can be assessed with the aid of an ultrasound device that is part of a colonoscope," Weinstein says.

45392 explained: "In other instances, the gastroenterologist may perform these procedures to determine the depth of an invasion of a cancerous mass seen visually with a standard colonoscope. If necessary, it is also possible to biopsy a lesion through the wall of the colon using the ultrasound pictures to guide the needle into the area of concern," Weinstein says.

In the past, coders were most likely to use an unlisted-procedure code (e.g., 45999, Unlisted procedure, rectum) when reporting these types of procedures. While most offices still don't have the instruments to perform EUS and fine needle colonoscopies, the procedures are gaining wider use, Weinstein says.

Stretta Emerges From Category III

CPT 2005 will also sport a shiny new code for the Stretta procedure, which a gastroenterologist would perform on a patient with gastroesophageal reflux disease (GERD). When the gastro performs the Stretta procedure in 2005, you should report 43257 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease).

Stretta Coding Still Evolving

The introduction of the 43257 code is just the latest in a long and complicated coding history for the Stretta procedure. In 2004, CPT gave Stretta Category III (temporary) status and its own code, 0057T (Upper gastrointestinal endoscopy, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with delivery of thermal energy to the muscle of the lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease).

Before 2004, you reported Stretta using 43499 (Unlisted procedure, esophagus) or some other code (or code combo) that resembled the procedure - and neither option led to consistent reimbursement success.

Experts Agree: Stretta Still a Tough Sell to Payers

Weinstein says that the inclusion of a CPT code for Stretta may not have the desired effect. "Even though AMA CPT may approve a new permanent code, I have not heard that the service will be covered by Medicare. Most insurers still consider the procedure to be experimental," he says.

But at least now there is hope of the Stretta procedure gaining wider acceptance (and payment) among insurers.

"As a Category III code (0057T), Stretta wasn't always easy to get reimbursed. Maybe now (that there is a permanent code), the 'experimental' status will be removed," says Linda Parks, MA, CPC, CMC, CCP, an independent coding consultant in Marietta, Ga.

Codes Must Be Used on Jan. 1

When CPT does release its final code list for 2005, make sure you start learning the codes immediately, because you must begin reporting the codes on Jan. 1, 2005. Remember, the 90-day grace period you used to get when new codes were introduced is no more.

Best bet: Make sure the entire coding office knows the new codes inside-out before the office closes for the December holidays. Also, don't forget to let staff know about the relevant CPT deletions for 2005.

Note: Look for future articles on how to use these new codes in future editions of Gastroenterology Coding Alert.