Gastroenterology Coding Alert

Question: Why do some carriers reimburse for 0008T and others don't?

Maryland Subscriber
 
Answer: Consider yourself lucky that you are receiving reimbursement from any carriers when you report 0008T (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with suturing of the esophagogastric junction).
 
Code 0008T is a new-technology, category III CPT code that represents an esophagogastroduodenoscopy with suturing of the EG junction. CPT includes these temporary codes for data collection. The goal is to collect enough data to determine if it is necessary to add a permanent category I CPT code to the manual. The government is able to retrieve information about the various uses of the technology, the medical necessity of this technology, the outcomes, etc., all of which it can use to determine whether it wants to cover the service. The government can also use this information to decide if it desires any future involvement in creating a policy to determine what ICD-9 codes will be considered medically necessary.
 
Many carriers do not reimburse for new-technology codes, so check with your carrier before you submit a claim for 0008T and get your reimbursement hopes up.