General Surgery Coding Alert

CPT® 2022:

Expand Your GI Endoscopy Coding Options This Year

Published on Fri Jan 21, 2022

Greet Category III codes for more options.

From transnasal to capsule endoscopy and more, CPT^® 2022 offers code changes you need to know for your general surgeons’ gastrointestinal (GI) services.

Read on for our experts’ guidance on relevant coding options and coverage matters.

Don’t Miss Category III Changes

Many of the new or deleted GI endoscopy codes appear in the Category III section of CPT^® 2022.

Key: Often called “T” codes, CPT^® Category III codes are temporary, five-character codes ending in “T.” The codes describe emerging technology and act as tracking codes to help determine how often a particular service or procedure may be utilized in the future, according to Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York Stony Brook.

As temporary codes for emerging technology, many payers consider the procedures investigational. That means payment for the services varies among payers, and there are no relative value units (RVUs) on the Medicare Physician Fee Schedule (MPFS) associated with these codes.

Tip: “When applicable, you should bill for a Category III code in place of an existing Category I code so long as the code description aligns with the surgeon’s work. Category III codes will remain in their respective section of the CPT^® code book for up to five years before either being removed or converted to a Category I code,” says Ferragamo.

Example: CPT^® 2022 adds new code 0647T (Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report) for a GI procedure to insert a tube through the abdominal wall into the stomach using an external magnet and ultrasound guidance for positioning. The procedure is distinct from existing gastrostomy codes using more traditional open or endoscopic approaches, such as 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube) or 43830 (Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure) (separate procedure)).

Sniff Out New Transnasal EGD Codes

You’ll find the following three new esophagogastroduodenoscopy (EGD) codes for transnasal approach in CPT^® 2022:

0652T (Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure))
0653T (… with biopsy, single or multiple)
0654T (… with insertion of intraluminal tube or catheter)

For a similar procedure that evaluates only the esophagus, CPT^® provides the following two existing codes:

43197 (Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure))
43198 (… with biopsy, single or multiple)

Surgeons may welcome the new Category III codes for cases that indicate the need for a transnasal approach to access beyond the esophagus in the GI tract.

“The transnasal approach may be quicker and more-easily tolerated by patients than traditional transoral EGD procedures, involving only a numbing medication in the throat and nose,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, California.

Transoral: For parallel transoral rather than transnasal EGD procedures, you should turn to the following existing codes:

43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure))
43239 (… with biopsy, single or multiple)
43241 (… with insertion of intraluminal tube or catheter)

“CPT^® provides many other transoral EGD codes that include specific additional services, such as FNA with ultrasound guidance (43238), mucosal resection (43254), lesion ablation (43270), and others in the range 43235-43270,” Brame Joy says.

Master Capsule Endoscopy Options

With some additions and deletions, CPT^® 2022 widens coding options beyond existing choices to describe capsule endoscopy procedures. These services involve using a wireless camera in a small “pill” that travels through a portion of the patient’s GI tract to provide images similar to what the surgeon may acquire through endoscopy procedures. Initially, clinicians were using these services to access only the small intestine that traditional endoscopy cannot reach, but now they are expanding applications of the technique.

For instance: New code 0651T (Magnetically controlled capsule endoscopy, esophagus through stomach, including intraprocedural positioning of capsule, with interpretation and report) describes a twist on the method, allowing the surgeon to gather images of the esophagus and stomach using a magnetically guided camera capsule.

Code switch: CPT^® 2022 deletes temporary code 0355T (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report) and replaces it with a new permanent Category I code with the same definition: 91113 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report).

Existing codes: Code 91113 joins an existing code family that describes capsule endoscopy of different portions of the GI tract, as follows:

91110 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report)
91111 (… esophagus with interpretation and report)
91113 (… colon, with interpretation and report)

Coder tip: Capsule endoscopy procedures typically begin with the patient swallowing the capsule and donning an external recorder for the images, but the procedure may end on a subsequent date. Medicare and many other payers require you to list the date of service as the day the procedure begins. According to the CMS document “Capsule Endoscopy Billing and Coding Guidelines,” the date of service “should be entered as the date hook-up is performed, with a number of service of one, regardless of the number of days the recorder is worn” (downloads.cms.gov/medicare-coverage-database/lcd_attachments/30141_14/L30141_GI009_CBG_030112.pdf).