Gastroenterology Coding Alert

The new CPT 2000 has several changes that will interest gastroenterologists, most notably in the evaluation and management (E/M) services area and the addition of a new modifier. What follows is a summary of the most important changes, along with comments from the Gastroenterology Coding Alert editorial advisory board.

Digestive System Section

Only one code of note for gastroenterologists in the manuals digestive system section has been revised. The gastrostomy tube placement code 43761 now specifically allows for the repositioning of a gastric feeding tube by any method (CPT 2000, page 196).

Pathology and Laboratory

Several of the panels frequently used by gastroenterologists to more precisely diag-nosis patient conditions have been revised for 2000. (** Denotes new addition to panel.)

Basic metabolic panel. Code 80048 replaces the old code 80049, which has been deleted. The tests in the panel now include calcium**, carbon dioxide, chloride, creatinine, glucose, potassium, sodium, urea nitrogen (BUN) (CPT 2000, page 343).

Comprehensive metabolic panel. Code 80053 replaces the old code 80054, which has been deleted. This panel no longer can be used with the basic metabolic panel (80048) or the hepatic function panel (80076). The tests in the comprehensive metabolic panel now include albumin, bilirubin; total, calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, phosphatase; alkaline, potassium, protein; total, sodium, transferase (ALT) (SGPT)**, transferase (AST) (SGOT), and urea nitrogen (BUN) (CPT 2000, page 343).

Acute hepatitis panel. Code 80074 replaces the old code 80059, which has been deleted. The tests in this panel now include hepatitis A antibody (HAAb); IgM antibody**, hepatitis B core antibody (HbcAb); IgM antibody**, hepatitis B core antibody (HbsAg); IgM antibody, hepatitis B surface antigen (HbsAg), and hepatitis C antibody. The hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HbcAb), IgG and IgM tests were removed from this panel (CPT 2000, page 345).

Hepatic function panel. Code 80076 replaces the old code 80058, which has been deleted. The tests in this panel now include albumin, bilirubin; total, bilirubin; direct, phosphatase; alkaline, protein; total**, transferase; alanine amino (ALT) (SGPT), and transferase; aspartate amino (AST) (SGOT) (CPT 2000, page 345).

Helicobacter pylori. Code 83013 now stipulates that the breath test analysis is done through mass spectrometry (CPT 2000, page 360).

Evaluation and Management Services

The CPT 2000 evaluation and management (E/M) services section has several revisions. First, time spent with parties who have assumed responsibility for the care of the patient, whether or not they are family members, can be considered a key or controlling factor to qualify an evaluation for a particular level of service. Previously, gastroenterologists could be reimbursed only for the time spent with family members. That now has been expanded to include foster parents, persons standing in locum parentis, legal guardians and others (CPT 2000, page 8).

There also are several changes in the criteria for a consultation, many of which mirror the recently updated Medicare criteria (see Medicare Clarifies Coding for Consultations, October 1999, page 1). A physician consultant now can initiate diagnostic and therapeutic services at the same or subsequent visit and still consider the evaluation to be a consultation. This revision matches CPT 2000 (CPT 2000, page 15).

The new CPT removes the documentation requirement of must from the attending physician in a consultation, with the manual stating that the request may be made by a physician or other appropriate source and documented in the patients medical record (CPT 2000, page 15). This revision is not the same as Medicares criterion, which says that the request from the attending physician must be documented in the patients medical record.

On the other hand, CPT 2000 specifies that the follow-up report issued by the consulting physician must be written, which puts the CPT guidelines in line with Medicares (CPT 2000, page 15).

To clarify the use of follow-up consultation codes, CPT 2000 advises consulting physicians in a hospital setting to use the appropriate inpatient hospital consultation code for the initial encounter and then hospital care codesnot follow-up consultation codesfor subsequent evaluations (CPT 2000, p. 16).

New Modifier -91

With CPT 2000, one modifier has been revised and another added. Modifier -32 (mandated services,) has been expanded to cover those services related to a consultation mandated by a governmental, legislative or regulatory requirement (CPT 2000, page 455).

Modifier -91 (repeat clinical diagnostic laboratory test) is a new level 1 modifier approved for ambulatory surgery center hospital outpatient use. This modifier is to be used when the same laboratory test must be repeated on the same day to obtain subsequent test results. The modifier may not be used when tests are re-run to confirm initial results because of testing problems with specimens or equipment or for any other reason (CPT 2000, pages 458-459).