Gastroenterology Coding Alert

Remember the multiple-scope rule when coding, checking reimbursement If you-re reporting multiple endoscopic procedures during the same surgical session, you have to ask yourself an important question: Are the scopes the physician performed in the same code -family-?

If so, the multiple-scope rule specifies that you cannot report the base, or -parent,- code separately with more extensive scopes in the same family. In addition, you will face a fee reduction for multiple scopes in the same code family. Include the Parent Code You should always include a diagnostic scope in a surgical scope, according to CPT rules. As a more general statement, you should always include the base, or parent, endoscope in any more extensive endoscope(s) from the same family that the gastroenterologist provides on the same day, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CPC-EMS, CodeRyte Inc. coding analyst and coding review teacher.

Example: The gastroenterologist performs a diagnostic sigmoidoscopy (45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), followed by sigmoidoscopy with control of bleeding (45334)
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In this case, you would report only the control of bleeding because 45334 already includes (bundles) the work described by 45330.

In other words: Because 45330 is a parent code, you would report it separately only if the gastroenterologist did not provide any services in the 45331-45345 range, Jandroep says. Note also that the descriptor for 45330 includes a -separate procedure- designation, meaning that you may not report this diagnostic scope separately with similar procedures. If No Parent, Bill All Applicable Scopes If the gastroenterologist performs two scopes in the same family, neither of which is the base procedure, you may report both codes, says Linda Martien, CPC, CPC-H, a coding consultant with National Healthcare Review Inc. in Woodland Hills, Calif.

Example: The gastroenterologist performs biopsy with sigmoidoscopy followed by endoscopic removal of a foreign body. In this case, neither scope is the base or parent procedure. Therefore, you would report both 45331 (... with biopsy, single or multiple) and 45332 (... with removal of foreign body). Fee Schedule Can Help You Identify Base Codes If you-re looking for a fast and easy way to identify endoscopic base codes, just consult the CMS Physician Fee Schedule, available as a free download from the CMS Web site http://www.cms.hhs.gov. Use the -search- function to find -PFS relative value files.-

After downloading the fee schedule, you can open an Excel file that lists all the CPT codes in numerical order. Column X of the fee schedule (labeled -Endo Base-) tells you the endoscopic base code for the code that you select from column A. If there is no code in column X, the code in column A is the base [...]