General Surgery Coding Alert

Question: Sometimes when a physician refers a patient to our surgeon to assess liver fibrosis using a method such as needle core biopsy, the surgeon may recommend and perform ultrasound-based elastography instead, as a non-invasive option for certain high-risk patients. How should we code for this procedure — is it an unlisted code?

Texas Subscriber

Answer: No, you should not use an unlisted code such as 91299 (Unlisted diagnostic gastroenterology procedure) for this procedure, because CPT^® provides a more specific code.

Instead, you should list 91200 (Liver elastography, mechanically induced shear wave [eg, vibration], without imaging, with interpretation and report), for testing the elastic properties of the liver to help evaluate fibrosis due to conditions such as viral hepatitis, alcoholic cirrhosis, drug-induced liver injury, etc.

The code includes the shear wave vibration test, the interpretation, and the report, but not imaging. . If the surgeon performs elastography using ultrasound guidance, report code 0346T (Ultrasound, elastography [List separately in addition to code for primary procedure]) in addition to 91200. If the surgeon performed an evaluation and management service on the same day, you may separately report that service as well.

Many payers do not yet cover this procedure, because they still consider it experimental or of unproven effectiveness. You should still report the procedure using the appropriate codes. Doing so is an important step in the eventual approval for coverage. Check with your payer to verify their reporting requirements. You should document necessity to establish why the provider chose this procedure over some other treatment.