Gastroenterology Coding Alert

Question: My gastroenterologist wants to do a gastric emptying study in the office. Are there restrictions on such studies in the office setting in terms of equipment cost and radioisotope costs? Are there any requirements that a radiologist must read the study?

Washington Subscriber

Answer: You won’t find any readily available evidence to suggest that your physician has any restrictions on performing such scans in an office setting. However,what is certain is that you should obtain a prior authorization and substantially prove medical necessity before performing a gastric emptying scan. You will see some indications for which 78264 (Gastric emptying study) is a covered diagnosis, but 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.

Also, although you won’t find any contrarian clinical issues to discourage a gastroenterologist performing the study, 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 the gastroenterologist has these credentials, she cannot perform the scan.

Along with reporting the procedure with 78264, you should also report the appropriate code for the supply of the radiopharmaceutical. For gastric emptying scans, the radiopharmaceutical used is Technetium Tc-99m Sulfur Colloid reported using A9541 (Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries) or Indium -111 Diethylenetriamine Pentaacetic acid (DTPA) reported using A4641 (Radiopharmaceutical, diagnostic, not otherwise classified). Additionally, 78264 has a TC (Technical component) and professional component ­­— so if the gastroenterologist is only providing the interpretation for the procedure, you can report the code using modifier 26.