Gastroenterology Coding Alert

Question: My provider wants to do the gastric emptying study (78264) in the office. She is a gastroenterologist. Are there any requirements that a radiologist must read the study, and is it even possible to do them in the office setting in terms of equipment cost and radioisotope costs? Any help would be appreciated.

New Orleans Subscriber

Answer: Although there are no clear guidelines on whether or not there is any restriction on performing such scans in an office setting, it is mandatory that a prior authorization should be obtained before performing gastric emptying scan. Also, medical necessity for performing the scan should be proved.

There are some indications for which 78264 (Gastric emptying study) is a covered diagnosis and coverage will not be provided if the diagnosis is not covered. Some of the covered diagnoses include gastroparesis (symptoms), dumping syndrome, gastric outlet obstruction, dysphagia, incontinence of feces, intestinal obstruction, dyspepsia, etc.

Even though there are no clear cut instructions on whether or not a gastroenterologist can perform the study, you should note that the use of radiopharmaceuticals is strictly governed by guidelines and is regulated by the Nuclear Regulatory Commission (NRC). A person administering radiopharmaceuticals should have either a license from the NRC or be credentialed by an institution having a broad license from the NRC. So, unless your gastroenterologist has these credentials, she cannot be performing the scan.

Along with reporting the procedure with 78264, the appropriate code for the supply of the radiopharmaceutical should also be used. For gastric emptying scans, the radiopharmaceutical used is Technetium Tc-99m Sulfur Colloid, Diagnostic reported using A9541 or Indium -111 DiethylenetriaminePentaacetic acid (DTPA) reported using A4641.

Coding tip: Note that 78264 has a TC and professional component -- so if your gastroenterologist is only providing the interpretation for the procedure, the code can be reported using the modifier 26 (Professional component).