Gastroenterology Coding Alert

Gastroenterology coders will finally be able to specify "Barrett's esophagus" (530.85) and "early satiety" (780.94) - thanks to the new ICD-9 codes CMS unveiled in the May 19 Federal Register. The new codes take effect Oct. 1.
 
The three most interesting new codes for gastroenterology - 530.85, 530.21, and 780.94 - will benefit practices by providing them with more precise codes for disease management and data analysis, says Linda Parks, MA, CPC, CCP, coding and billing coordinator for GI Diagnostic Endoscopy Center in Atlanta. In addition, two of the three codes will also pay dividends when it comes to reimbursements, she adds.
 
Parks highlights the following new ICD-9 codes as key for gastroenterology coders:
 
1. Barrett's esophagus (530.85). Coders will be especially glad to see this one, Parks says. Having a code for Barrett's esophagus will be a big help in terms of disease management and for tracking patient treatment. "You have to follow your Barrett's patients closely. They have to have scopes done on a regular basis, watching for dysplasia," she says.
 
With the inclusion of 530.85, Parks says, managing the treatment of the condition just got one step easier. By running a report on the new ICD-9 code, you can now quickly and easily ensure that you are calling in all of the Barrett's patients for their regular checkups, she says.
 
In the past, coders have been relegated to using a less descriptive code for Barrett's. Using the more general code made tracking specifics about patients and their conditions - who had what, when - more difficult. Coders couldn't provide as much detail as they would have liked about the individual patient's health. "You're not getting a true picture of the condition if you have to use the non-descript code," Parks says.
 
2. Ulcer of esophagus with bleeding (530.21). Never specified before, this new code allows you to provide details around control of bleeding for an esophageal ulcer. Using this code, with its added detail, will help you get your reimbursements easier and with less paperwork than in the past.
 
Previously, you did not have a code that described the state of the ulcer; you simply had to use the general code for esophageal ulcer. If you had to control for bleeding, the lack of detail in the code could raise questions from your carriers. "Say you code for control of bleeding, and you use 530.2, which is just ulcer of the esophagus. They [the carriers] may question that because it does not specify that this ulcer was bleeding," Parks says. To support the diagnosis, coders have had to send a stack of documentation to support the code or, worse, deal with denials and appeals. This is especially true when dealing with private carriers.
 
The new code provides you with the detail you need to code claims successfully and conveniently, avoiding some of the paperwork - and headaches - of the past.  "On the reimbursement end, you're not going to have near as much to try to prove to the carriers," says Amy Walker, CPC, CCP, of Gastrointestinal Associates PC, of Knoxville, Tenn.  "[Having the new code] makes it 10 times easier, and with less appeals," Walker says.
 
CMS also included 530.20, Ulcer of esophagus without bleeding, along with 530.21, adding a fifth digit to what had typically been the diagnostic code for all esophageal ulcers.
 
3. Early satiety (780.94). Often seen with patients complaining of epigastric pain, early satiety had been relegated to the nonspecific code 537.89, which ICD-9 literally defines as simply "Other."
 
Coding "other" as a diagnosis often equates to "$0.00" when it comes to payment from many carriers.  "When you code 'other,' your reimbursement will depend heavily on the carrier," Parks says. "Some state Medicare carriers will not pay for that code ... period." From a coder's perspective, 780.94 offers greater detail for the patient's record - and for your billing statement.