Gastroenterology Coding Alert

(Note: For a list of all of the G codes Medicare expects you to use in 2005, see Clip N Save: Ease Adjustment Period By Posting These G Codes).

Don't wait to put these on your claims, because the G codes were effective on Jan. 1, and CMS removed the grace period.  If you use the old CPT codes for injections/infusions, Medicare will not reimburse in 2005, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga.

Take note: Medicare has also changed the rules on reporting everything from a simple therapeutic injection to an eight-hour infusion session, so you should know the new guidelines to avoid payment problems.

Here's how our experts say you should use the new G codes in your office.

Use G0345-G0346 for IV Hydration

Medicare has mandated comprehensive changes for coding that describes intravenous (IV) procedures focused on hydration. When you report an IV hydration procedure to Medicare in 2005, you should report:

Coding Impact: In 2005, Medicare will not accept the following codes for IV hydration procedures infusions:
 

Do it this way:  Consider this coding scenario in which you use the new IV hydration G codes. Information comes courtesy of Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel:
 
Scenario: A Medicare patient with a several-day history of vomiting and diarrhea is seen in the office and found to have very low blood pressure and tachycardia indicative of dehydration.  The physician orders infusion of 1,000 milliliters of normal saline solution given over three hours.
 
When filing with Medicare, you should:
 

Changes Affect Remicade Delivery Reporting

Further, Medicare will not accept 90780 or 90781 for delivery of Remicade (Infliximab), a drug gastroenterologists deliver via infusion to treat patients with severe Crohn's disease.

When your gastroenterologist delivers Remicade to a patient via infusion, Medicare wants you to report:
 

Example: A patient reports to the office for a Remicade infusion session that lasts three hours. When filing with Medicare, you should:
 

Parman warns coders against using these G codes in a non-office setting, though. Remember, a physician can only report infusion therapy when it's performed:
in a physician's office, by the employed staff of the practice, and under the direct supervision of the billing physician.

"[Infusion therapy] is not billable by a physician if the infusion is performed in a hospital outpatient or inpatient facility," Parman stresses.

Reporting Photofrin Admin? Check G Codes First

If your office administers Photofrin, which is a crucial part of PDT, coding will be much different for that procedure as well. To report Photofrin admin properly to Medicare, you'll have to get used to using a new G code.

What's PDT for? When a patient has localized esophageal cancer (or Barrett's Esophagus), the gastroenterologist may treat her with PDT. The first step of PDT involves IV administration of Photofrin, which the gastroenterologist usually delivers by injection or IV push.  This delivery method has a new Medicare G code.

Example: Let's say a Medicare patient with Barrett's Esophagus reports for her first PDT session, and the gastro injects Photofrin via push technique. You should:
 

Whether or not private payers adopt these G codes depends on the payer, according to a November presentation titled "2005 Physician Fee Schedule: Complex Infusion Coding Update," presented by Centocor, Inc., of Malvern, Penn. (Centocor is a Remicade manufacturer.) 

Gastro offices should update their billing and management systems  to include the new Medicare G codes, but "physicians may be required to use both new G codes and existing codes in 2005, depending on the payer. Other payers [than Medicare] may not adopt the G codes," according to Centocor. The best advice? Before you file a claim to any insurer with these new codes, call and speak to a representative first.