Gastroenterology Coding Alert

Question: Two gastroenterologists in our practice use different codes to report a liver biopsy. Both use ultrasound guidance and admit the patient for 23-hour observation. One uses 47000 (biopsy of liver, needle; percutaneous) for the biopsy and 99218 (initial observation care) for the 23-hour observation. The other also uses 47000 for the biopsy, but uses 76975 (gastrointestinal endoscopic ultrasound, radiological supervision and interpretation) to report the ultrasound guidance and does not report the 23-hour observation. Who is correct?

Gaye Smith, Atlanta

Answer: According to the Medicare Physicians Fee Schedule database, code 47000 has zero global days, says Cynthia Thompson, CPC, senior consultant with Gates, Moore & Co., a healthcare consulting firm in Atlanta. This means that evaluation and management (E/M) services provided on the same day as the procedure are included in the gastroenterologists fee. Therefore, the initial observation service should not be billed if it is performed on the same day as the liver biopsy, unless the observation is for a separately identifiable cause.

Because code 76975 does not mention ultrasonic guidance, Thompson suggests that the gastroenterologists read the description of 76942 (ultrasonic guidance for needle biopsy, radiological supervision and interpretation) to see if it better describes the work that was done. Both of these radiological codes have a technical and professional component. If the hospital owns the ultrasound equipment, then the gastroenterologists must attach modifier -26 (professional component) to the procedure to indicate that they did the interpretation of the ultrasound.