Gastroenterology Coding Alert

Do you bill twice when replacing a PEG tube? If so, you should take a close look at the latest National Correct Coding Initiative (NCCI) edits; it could change the way you think.
 
The NCCI version 9.3 edits took effect Oct. 1 and will be the rule until Dec. 31, so all relevant changes need to be noted to avoid red tape. Gastroenterology offices will be most affected by four new NCCI bundles. Here is a look at these new bundles and what you need to look for to eliminate improper filings and maximize payment in light of the new edits. NCCI Brings Biopsy Bundles to Esophagoscopy  The procedures NCCI has bundled into 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) will likely shock no one. When an esophagoscopy is performed, all stomach or intestinal biopsies conducted during it should be bundled into 43239. This edit removes all doubt about billing 43600 (Biopsy of stomach; by capsule, tube, peroral [one or more specimens]) or 44100 (Biopsy of intestine by capsule, tube, peroral [one or more specimens]) in addition to the endoscopy (or esophagogastroduodenoscopy).
 
"These are not surprising, and I can't imagine that anyone would bill both codes - except to game the system," says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel. Although these edits all have an indicator of "1"  - meaning that the procedures can be separately reported for a single patient encounter that meets certain criteria - Weinstein doesn't think they would apply in most situations. Fluoroscopy Is Now Part of ERCP When you report a standard endoscopic retrograde cholangiopancreatography (ERCP), the procedural codes (43260-43272) now include fluoroscopy, regardless of the time or resources expended. The edit nullifies the possibility of reporting the ERCP and then separately coding the fluoroscopy with either of the following:

76000 - Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (e.g., cardiac fluoroscopy)

76001 - Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician (e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy). This edit is new for the NCCI, but the revision probably won't be revelatory to most coders, says Linda Parks, MA, CPC, CMC, CCP, of GI Diagnostics Endoscopy Center in Marietta, Ga.

"The spring 1994 CPT Assistant and the June 2000 GI Coding Alert had already reported that these codes were not to be billed together," Parks says. "The use of contrast material and the fluoroscopy are standard components of ERCPs." No More Double-Billing for PEG-Tube Replacement In the world of PEG procedures, the NCCI has closed a loophole that may have allowed double-billing when a [...]