Gastroenterology Coding Alert

Optical endomicroscopy (confocal endomicroscopy) is a new technique that has been developed to take high resolution images within optically thick tissue in real time. This technique is useful in detection of pre-cancerous conditions, Barrett’s esophagus, and lesions in the colon and rectum.

“Optical microscopy is also used to enhance the analysis of pancreatic cysts during endoscopic Ultrasound and fine needle aspiration (EUS – FNA),” says Michael Weinstein, MD, Gastroenterologist at Capital Digestive Care in Washington, D.C., and former representative of the AMA’s CPT^® Advisory Panel. 

During the procedure, the physician uses a flexible fiber–optic endomicroscopy system, which was developed for nonlinear optical imaging of biological samples. It uses a low-powered laser to be focused on the point of detection. The light emanating from within the tissue is then directed onto the detector that gives an image of very high resolution from a thin section within optically thick tissue.

This procedure is being increasingly used in gastroenterology as it eliminates the need to perform biopsy of random sites. When your gastroenterologist performs this procedure and also performs a same session biopsy, you will need to check documentation to identify the procedures your gastroenterologist performed and use appropriate modifiers to report both procedures together. As per Correct Coding Initiative (CCI) edits, you can report both procedures but you will have to use a modifier such as modifier 59 (Distinct procedural service) appended to the biopsy code (43202 or 43239).

Your gastroenterologist will use exogenous contrast agents such as acriflavine hydrochloride, fluorescein sodium or cresyl violet. These agents are applied topically or introduced intravenously prior to the endomicroscopy. When checking documentation, you will have to look for the contrast agent used in the procedure, as you will have to report this separately in addition to the CPT^® code that you will be billing out for reimbursement of the procedure.