Gastroenterology Coding Alert

Plus: CPT^® 2025 will roll out a new virtual check-in code.

New gastroenterology-related Category I CPT^® codes are in short supply this year, but the debut of CPT^® 2025 brings the addition of Category III codes to describe colonoscopy, sigmoidoscopy, and esophagoscopy procedures.

Background: The AMA previewed the 2025 CPT^® codes on Sept. 1, 2024. Amid the changes, you’ll find 270 new codes, 38 revisions, and 112 deleted coding options.

Check out the key facts that gastroenterology coders must know to prepare before the coding updates debut on Jan. 1, 2025.

Eye New Cat III Codes

CPT^® lists “temporary” codes with four numerals followed by “T” in the Category III section. The AMA assigned these temporary codes to represent emerging technologies, services, procedures, and service paradigms. These codes are published on the AMA website every six months following approval by the CPT^® Editorial Panel.

Three such codes relevant to gastroenterology coders are debuting on January 1:

• 0884T (Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for esophageal stricture, including fluoroscopic guidance, when performed)
• 0885T (Colonoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed)
• 0886T (Sigmoidoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed)

The purpose of Category III codes is to allow data collection regarding how often clinicians perform a particular service. That means you should not use an unlisted Category I code if CPT^® provides a Category III code for a procedure — the latter takes priority, according to the section guidelines.

New guidance in the Category I section of the CPT^® code set makes that point crystal clear. For instance, a new parenthetical guideline listed under 45386 (Colonoscopy, flexible; with transendoscopic balloon dilation) states: “For colonoscopy with predilation followed by therapeutic drug delivery by drug-coated balloon catheter, use 0885T.”

Category III codes have an expiration date, which is typically after five years. Before expiration, the AMA either converts the procedure to a Category I code or archives the code due to limited use.

Payment: Neither the AMA Relative Value Scale Update Committee (RUC) nor the Centers for Medicare & Medicaid Services (CMS) assigns relative value units (RVUs) to Category III codes. That means there is no established fee schedule for the codes. Individual payers will establish coverage and payment for these codes.

Regardless of current pay, however, you should report Category III codes if you perform the described services. Reporting the Category III codes provides the data for clinical usage that could impact conversion to a Category I code and future payment.

Prep for New Telemedicine Options

It’s not every day that new evaluation and management (E/M) codes debut, but that’s exactly what will happen in 2025 with the addition of an entirely new telemedicine section, unless CMS decides otherwise in its final rulemaking, due out soon. If this goes forward, you’ll find 17 new telemedicine codes in the list of your E/M options effective January 1.

First, you’ll find four codes describing audio-video telemedicine visits for new patients:

• 98000 (Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.)
• 98001 (… which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.)
• 98002 (… which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.)
• 98003 (… which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.)

If you perform audio-video visits with established patients, you’ll choose from these four codes:

• 98004 (Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.)
• 98005 (… which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.)
• 98006 (…which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.)
• 98007 (… which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.)

You’ll also find several new audio-only telemedicine codes, with four for new patients (98008-98011) and four for established patients (98012-98015). These codes will replace the existing telephone-only codes (99441-99443), which will be deleted as of January 1.

In the Proposed 2025 Medicare Physician Fee Schedule, CMS said: “We do not believe that there is a programmatic need to recognize the audio/video and audio-only telemedicine E/M codes for payment under Medicare.” However, that doesn’t mean these new codes won’t be reimbursable. The 2025 Medicare Physician Fee Schedule final rule is expected to debut within the next month, and at that point it will be clearer whether these telephone codes will be payable by Medicare.

Gastroenterology coders should also prepare for one additional new E/M code: 98016 (Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion).

You’ll report this code for brief virtual check-ins. Coders currently report HCPCS Level II code G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion) for this service.

Torrey Kim, Contributing Writer, Raleigh, N.C.