Gastroenterology Coding Alert

New medical technologies that do not have an established CPT code, such as the Stretta procedure or endoluminal gastroplication (ELGP), should use the new Category III codes whenever possible. If no Category III code exists, an unlisted-procedure (UP) code should be reported instead of using a combination of existing codes to report a single procedure.
 
CPT 2002 includes two changes that most gastroenterology practices may have considered to be of minor importance. The first was the introduction of Category III codes, which are temporary codes assigned to emerging technologies, services and procedures. The purpose of the Category III code, which contains an alpha character at the end, is to collect data on the use of these new procedures.
 
A Category III code is not meant to indicate that a technology is experimental, explains Joel Brill, MD, a gastroenterologist and the American Gastroenterological Association representative to the CPT editorial advisory panel. These procedures have received FDA approval, but providers need to check with their carrier or private payer in advance about the reimbursement for the procedure
 
The second change was that CPT made Category III codes mandatory to ensure that the new system can gather enough data. The CPT manual reads, "If a Category III code is available, this code must be reported instead of a Category I unlisted-procedure code."
Use 0008T for ELGP
The only gastroenterology code in the Category III section so far is for ELGP (0008T, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with suturing of the esophagogastric junction).
 
Note: Additional gastroenterology codes may appear in the biannual update to the Category III codes, which should be available at the beginning of July.
 
Many gastro practices that perform ELGP now bill with 43499 (Unlisted procedure, esophagus), which was correct last year. However, those practices should start reporting 0008T, whether they use the Bard EndoCinch device or another manufacturer's suturing device, Brill states. "If a Category III code exists, you have to use it," he says. "You don't have the option of using the unlisted-procedure code unless a carrier or payer has told you otherwise."

Don't Report Code Combos for a Single Procedure
There's also a new section in the introduction to CPT 2002 that reads: "Do not select a CPT code that merely approximates the services provided. If no such procedure or service exists, report the service using the appropriate UP or service code."
 
In this new text CPT is opposing using multiple codes or coding combinations to report a single procedure, Brill says. "It is becoming apparent that they [CPT and CMS] do not want code combinations used because that diminishes the use of Category III codes," he explains. "It is also becoming apparent [...]