Gastroenterology Coding Alert

Question: My gastroenterologist performed a liver elastography using mechanical shear wave technique, to investigate whether the tumors in the liver are nonmalignant. How do we report this procedure? Can we report 91299 for this procedure?

Utah Subscriber

Answer: The CPT^® code 91299 (Unlisted diagnostic gastroenterology procedure) is an unlisted code. However, since 2015 and onwards you have a specific CPT^® code 91200, (Liver elastography, mechanically induced shear wave [eg, vibration], without imaging, with interpretation and report), for testing the elastic properties of the liver without imaging, which would be more appropriate here. This code describes liver fibrosis evaluation, includes interpretation and report, but not imaging.

Previously, you could only report this service using 91299. If the provider performs elastography using ultrasound guidance, use code 0346T (Ultrasound, elastography [List separately in addition to code for primary procedure]). If the provider performed an evaluation and management service on the same day, it is separately reportable.

Many carriers do not yet cover this procedure, because they still consider it experimental or of unproven effectiveness. You should still report the procedure as an important step in the eventual approval for coverage. Check with your carrier to verify their reporting requirements. You should document necessity to establish why the provider chose this procedure over some other treatment.