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Gastroenterology Coding Alert

Reader Question:

Solve the M2A Capsule Enigma

Published on Wed Jan 01, 2003

Question: We recently purchased the new M2A Capsule technology to use with colonoscopies. What should I expect in the way of reimbursement, and how should we code for this procedure?

Vermont Subscriber

Answer: Given Imaging's M2A Video Capsule System is the new technology used to diagnose gastrointestinal disorders. As with any new technology, there will be questions and complications regarding reimbursement until carriers work out the billing system with doctors. At this point, many carriers are not giving full reimbursement for this procedure, so doctors are taking losses. Some local insurance carriers will not pay at all.

Beginning Jan. 1, 2003, Medicare has approved payment for the M2A Capsule for the evaluation of obscure gastrointestinal bleeding. The new APC (Ambulatory Payment Classification) code is #0711 with payment of $625. The new HCPCS code is G0262. The fee for the new HCPCS code has not yet been published. In addition, it is not clear how non-hospital outpatient sites (ASCs or physician offices) will be able to bill for the technical equipment because APCs only apply to hospital outpatient services.

Because APC codes and HCPCS codes work only for Medicare claims, there are three coding options for non-Medicare carriers:

  • 44376 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum;

    diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

  • 44799 Unlisted procedure, intestine
  • 91299 Unlisted diagnostic gastroenterology procedure.

    To bill for the capsule, report the unlisted supply code 99070 (Supplies and materials [except spectacles], provided by the physician over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]).

    Remember to list the device used next to the code. Also, you need to get prior authorization for the procedure. You may have an easier time getting paid when you discuss the procedure and other issues with carriers in advance. Many insurance companies have already developed policies for reimbursement and coding of M2A Capsule services.

     

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