Part B Insider (Multispecialty) Coding Alert

Gain proper reimbursement for gastrostomy tube conversion next year

It's official: The American Medical Association (AMA) has released the list of changes in CPT 2008. Here are some of the new codes you-ll have to work with:

Cardiac MRI: CPT 2008 deletes cardiac Magnetic Resonance Imaging (MRI) codes 75552-75556 and re-places them with eight new codes.

Old way: Codes 75552-75556 divided cardiac MRI into three groups: MRI for morphology, for function (with or without morphology) and for velocity flow mapping.

New way: Codes 75557-75564 all cover cardiac MRI for both morphology and function. The first four codes cover cardiac MRI without contrast material and the second batch of four includes cardiac MRI -without contrast material, but followed by contrast material(s) and further sequences.-

Each group of four further divides into plain cardiac MRI, cardiac MRI with flow/velocity quantification, cardiac MRI with stress imaging, and cardiac MRI with both flow/velocity quantification and stress imaging.

So you-ll have to pay more attention to how your doctor documents cardiac MRI in 2008 to make sure you-re coding for further sequences, stress imaging and other additional services, when applicable.

Gastrostomy tubes: You-ll have nine new codes for insertion and other procedures involving gastrostomy and other tubes.

Old code: CPT 2008 deletes 43750 (Percutaneous placement of gastrostomy tube, without imaging or endoscopic guidance).

New codes: Three new codes cover insertion of gastrostomy (49440), duodenostomy or jejunostomy (49441), or cecostomy or other colonic (49442) tubes. The insertion is -under fluoroscopic guidance including contrast injection(s), image documentation and report.- And CPT 2008 deletes 74350, which you currently use for fluoroscopic guidance for tube placement.

You-ll use three other new codes when your physician replaces a gastrostomy or cecostomy (or other colonic) tube (49450), a duodenostomy or jejunostomy tube (49451), or a gastro-jejunostomy tube (49452).

Also: New code 49446 will come in handy when your physician converts a gastrostomy tube to a gastro-jejunostomy tube. Another new code (49460) covers the mechanical removal of obstructive material from a gastrostomy or any other type of tube. And finally, 49465 covers contrast injection(s) for radiological evaluation of an existing tube, including image documentation and report.

CPT 2008 also changes the wording of gastrostomy tube change code 43760. The new wording clarifies that the change of gastrostomy tube is percutaneous and -without imaging or endoscopic guidance.-