Gastroenterology Coding Alert

Gastroenterologists can no longer bill radiology code 76942 with an esophagoscopy with endoscopic ultrasound and fine needle aspiration (EUS/FNA, 43232) and esopha-gogastroduodenoscopy (EGD) with EUS/FNA (43242) due to new edits in the latest version of the Correct Coding Initiative (CCI).

On page 82 of the November 2001 Gastroenterology Coding Alert, several gastroenterologists reported billing 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) to get additional reimbursement for what they deemed were unreasonably low fees for the primary EUS/FNA procedure. However, in CCI version 8.1, which went into effect on April 1, 2002, 76942 is now a component of the comprehensive EUS/FNA codes. Curiously, there is not a similar edit yet for a flexible sigmoidoscopy with EUS/FNA (45342).

The most significant CCI additions to gastroen-terology codes in this version are in the comprehensive/ component list. Another set of new edits from this list bundles the biopsy codes (43202, 43239, 44361, 45331, 45380) for most parts of the gastrointestinal tract (esophagus through colon) with the codes for removal by hot biopsy forceps (43216, 43250, 44365, 45333, 45384) and the removal by snare technique codes (43217, 43251, 44364, 45338, 45385) in their endoscopic families.

This set of edits shouldn't be a surprise, because they were previously part of the "black box" or unpublished edits used by Medicare until October 2000. Earlier versions of the CCI said in the introductory section that when a biopsy is obtained and "subsequently excision, removal, destruction or other elimination of the biopsied lesion is accomplished, a separate service cannot be reported for the biopsy procurement as this represents part of the removal."

The biopsy edits have a superscript of 1, which means the edit can be overridden with modifier -59 (Distinct procedural service) and billed separately if the biopsy is separate and distinct from the comprehensive procedure.

Edits were also applied to the transendoscopic stent placement codes for the upper gastrointestinal tract (43256), small bowel without ileum (44370), and small bowel with ileum (44379). Predilation is included in the CPT definition of the procedure, so the CCI bundled most of the esophageal dilation codes (including 43245, 43248, 43249, 43450*, 43453 and 43458) into these three stent placement codes.

Finally, several control-of-bleeding codes were listed as components of several CPT codes that were established last year. An EGD with control of bleeding (43255) is now a component of EGD with transmural drainage of pseudocyst (43240), EGD EUS/FNA (43242), and EGD with transendoscopic stent placement (43256). The control-of-bleeding codes for enteroscopy without and with ileum (44366, 44378) have been bundled into enteroscopy with transendoscopic stent placement (44370, without ileum; 44379, with ileum).

These edits are consistent with other CCI edits on endoscopic control of bleeding. "Certain complications with an inherent potential to occur in an invasive procedure are, likewise, not separately reported unless resulting in the necessity for a significant separate procedure to be performed," the CCI states. "For example, control of bleeding during a procedure is considered part of the procedure and is not separately reported."

The control-of-bleeding edits also have a superscript of 1, which means the edit can be overridden with modifier -59 and billed separately if the control of bleeding is separate and distinct from the comprehensive procedure.