Gastroenterology Coding Alert

Question: What code should we use to bill for India ink tattooing of lesions?

Missouri Subscriber

Answer: Gastroenterologists often use India ink tattooing to permanently mark a lesion and make it easy to identify later. Despite its value to the patient, it is not considered by Medicare to be a reimbursable service. There is no specific CPT code for the procedure, and according to the Correct Coding Initiative (CCI), the identification of anatomical landmarks is one of many generic service for which it would be inappropriate to separately code based on standard medical and surgical principals.

While there is no CPT code for India ink tattooing, some gastroenterologists have achieved reimbursement by using an unlisted procedure code, says Pat Stout, CMC, CPC, an independent gastroenterology coding consultant and president of OneSource, a medical billing company in Knoxville, Tenn. To code for the markings of lesions during a colonoscopy, for example, 45378 (colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) should be used to report the colonoscopy and 44799 (unlisted procedure, intestine) should be used to report the India ink tattooing.

A description of the tattooing procedure must accompany the claim, Stout says. Unless a description of the procedure and the purpose for doing the tattooing is attached, the claim is no good, she says.