Gastroenterology Coding Alert

Keep abreast of all relevant edits to avoid denials

As if gastroenterology professionals didn't have enough new information to digest for 2004, the National Correct Coding Initiative (NCCI) has released its latest version of edits.
 
The new edits took effect on Jan. 1, 2004, and will be the law until the next quarter. Here is a sampling of some of the gastroenterology-specific codes that will be affected. (For more information, see a more comprehensive article on the NCCI edits in a future issue of Gastroenterology Coding Alert):

Esophagoscopy Coding Combos Nixed
 
Regarding mutually exclusive additions, coders will no longer be able to report 43216 (Esophagoscopy, rigid or flexible; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) with two codes, except in rare situations. These changes to the esophagoscopy codes will parallel those edits already in existence for EGD and colonoscopy codes.
 
In most cases, you can no longer report 43216 in combination with 43217 (Esophagoscopy, rigid or flexible; with removal of tumor[s], polyp[s] or other lesion[s] by snare technique) or 43228 (...; with ablation of tumor[s], polyp[s], or other lesion[s], not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique). And, 43228 and 43217 cannot be reported together under most circumstances.
 
There is a "1" indicator on all of these edits, meaning that reporting the procedures together is allowed in certain circumstances using modifier -59 (Distinct procedural service).

Proctosigmoidoscopy Codes Combined; Tube Placement Bundled

NCCI also bundled two codes into 45315 (Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique): 45308 (Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery) and 45309 (Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique).
 
This edit has a "0" indicator, meaning you cannot unbundle these procedures under any circumstances.
 
You should also get out of the habit of reporting 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]) when it is performed during gastrointestinal procedures, because NCCI has bundled it into many gastroenterology codes.

Read Them for Yourself

The NCCI edits are posted at http://cms.hhs.gov/physicians/cciedits/default.asp. The edits are presented as a spreadsheet, allowing users to sort by procedural code or effective date. The new Web page also includes links to documents that explain the edits, the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and the NCCI Question and Answer page.