Gastroenterology Coding Alert

Crohn's presents a coding challenge From diagnosis to treatment, reporting for Crohn's patients can be tricky. Follow these three steps to increase your reimbursement for Crohn's diagnosis, management and treatment.
 
Crohn's disease, also called ileitis or regional enteritis, is an inflammatory bowel disease (IBD) that typically irritates the small intestine but can also be found in any part of the digestive tract. Those with Crohn's disease have frequent pain from intestinal inflammation and often have diarrhea. There is no cure for Crohn's disease, but several treatments are available.
 
In many gastroenterology offices, not much time passes between visits from patients with Crohn's disease, according to Lois Curtis, CPC, of Gastroenterology Associates in Evansville, Ind.
 
"You go in spurts sometimes: You get a lot (of Crohn's patients), and then it tapers off a while," she says. "But we're always getting patients with Crohn's or diagnosing patients with it."  Identify Initial Visits That Are Consultations In many cases, a gastroenterologist's first encounter with a Crohn's patient is a "referral": The patient has some sort of gastroenterological problem, and her primary-care physician decides that a gastroenterologist's opinion is needed.
 
Even if a patient is found to have Crohn's disease and eventually comes under your office's care, the initial meeting with her is still a consultation.
 
If the patient reports initially because she (or her doctor) decided that a gastroenterologist's opinion was in order, choose the appropriate code from the outpatient consultation codes 99241-99245 (Office consultation for a new or established patient ...).

According to Delia Bartolotto-Stewart, CPC, of Digestive Health Physicians in Fort Myers, Fla., this is how most patients with Crohn's symptoms end up on her office's appointment books.
 
"A patient has a pain or diarrhea problem, the (primary-care) doctor isn't sure if it's Crohn's ... and our office determines that," she says.
 
If the gastroenterologist is to provide a second or third opinion about a patient with Crohn's symptoms, you should assign one of the confirmatory consult codes 99271-99275 (Confirmatory consultation for a new or established patient). Code the Chosen Method of Diagnosis Gastroenterologists have several options when testing for Crohn's disease. They can order simple blood tests to measure for an abnormally high number of white blood cells or a high sedimentation rate, a sign of inflammation somewhere in the body. They can also order fecal-occult blood tests to detect intestinal bleeding, a problem common to Crohn's.
 
Due to its sensitivity to lower-bowel bleeding, physicians most often use the guaiac-based test in fecal-occult tests; the proper CPT code for this test is 82270 (Blood, occult, by peroxidase activity [e.g., guaiac] qualitative; feces, 1-3 simultaneous determinations).
 
Perhaps the most common way to test for Crohn's is with colonoscopy, during which the physician can check for inflammation [...]