Ethically Optimize Payment For Upper GI Studies
Published on Sat Jul 01, 2000
Professional coders have expressed frustration over the codes that describe radiological exams of the upper gastrointestinal (UGI) tract. For the most part, their questions focus on two series of codes, 74240-74245 (radiologic examination, gastrointestinal tract, upper) and 74246-74249 (radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon). Each of these series covers distinct procedures performed under specific circumstances and easily can be confused unless the coder clearly understands the variables associated with each.
Also crucial to correct coding of these UGI exams is the documentation written in the patient record. If the radiologist doesnt clearly state the services performed and describe the contrast materials used, it will be impossible for the coder to know which code to assign.
These codes are often misrepresented, agrees Chris Sari, CPC, quality assurance manager for Advanced Radiology, which provides support to about 80 physicians, 24 freestanding facilities and eight hospitals in the Baltimore area. It is crucial that the study be clearly explained in the report and that the coder understand the specific components of the exam.
Dont Mistake Similar Procedures for UGI Studies
Coders must read the radiologists documentation carefully to ensure they dont confuse a GI study with similar exams. Because parts of the gastrointestinal anatomy are studied during a variety of procedures, it is important to identify the correct service.
For instance, although the esophagus is included in a UGI series, radiologists on occasion may perform x-ray exams of only the esophagus. This procedure would be coded CPT 74220 (radiological examination; esophagus) and would not be assigned a UGI code.
Editors note: Coders should be aware that 74220 is seldom reimbursed separately, because most third-party payers consider it a component of the UGI code.
Likewise, the small bowel often is viewed as part of a UGI study. But it also may be examined independently. In those instances, it would not be appropriate to assign any of the codes in the 74240-74249 series. Instead, coders would report 74250 (radiological examination, small bowel, includes multiple serial films) or 74251 (radiological examination, small bowel, includes multiple serial films; via enteroclysis tube).
Coders also must familiarize themselves with the conditions for which UGI studies are ordered most often. Indications for the exam may include gastritis (535.5x), duodenitis (535.6x), peptic ulcer disease (533.xx), gastric varices (456.8), neoplasms (211.0-211.9, 235.2, 235.5, 239.0, etc.) and gastric outlet obstruction (537.0). In addition, one of these studies may be ordered when patients have a history of or currently exhibit symptoms of abdominal pain, epigastric distress or discomfort, dyspepsia, nausea, vomiting, signs/symptoms of UGI bleeding, anemia and abdominal masses.
Contrast Medium Pinpoints the Series of Codes
Key to recognizing which upper GI [...]
