Answers to Your Questions on Screening Colonoscopies   (January 2002)

Due to recent publicity campaigns touting the benefits of colorectal cancer screenings and a new screening benefit for average-risk patients, more Medicare beneficiaries have been seeking screening colonoscopies from gastroenterologists. Because Medicare carriers have been slow to release updated guidelines for these benefits, the increase in demand for screenings has also brought an increase in questions, such as how to bill for an E/M service prior to the screening or the proper way to report [...]

You Be the Coder: Two ERCPs on Same Day   (January 2002)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code an attempted endoscopic retrograde cholangiopancreatography (ERCP) that was discontinued because the anatomy of the biliary tree made cannulation impossible. The gastroenterologist sent the patient to radiology and had a percutaneous trans-hepatic cholangiogram (PTC) catheter placed by the radiologist. After that, he was able to perform an ERCP with sphincterotomy and stent [...]

News Brief: Medicare Issues Memo on ICD-9 Coding for Tests   (January 2002)

CMS recently issued a memo (AB-01-144) clarifying its diagnostic coding guidelines for reporting diagnostic tests. The memo, effective Jan. 1, 2002, reaffirms the agency’s commitment to the Official ICD-9-CM Guidelines for Coding and Reporting. It also restates the ICD-9’s longstanding principal that physicians billing for the interpretation of a diagnostic test must report their diagnoses based on the results of the test, not the signs and symptoms that lead to the ordering of the test. [...]

Free Anthrax Coding Report on Web   (January 2002)

Physicians and other healthcare professionals who provide services to any patients with actual or possible anthrax exposure know that the encounters must be correctly coded. This is necessary for accurate health records and insurance claims; it is also mandated by law. Until now, however, there has been no central compendium of anthrax coding information and advice. Therefore, The Coding Institute organized a task force to provide a special report on anthrax coding. This 16-page report has been [...]

Medicare Payment Rules for 2002   (January 2002)

In its annual update of Medicare payment rules and the physician fee schedule database, CMS made the following rule changes of interest to gastroenterologists:  Screening flexible sigmoidoscopies performed by nurse practitioners, physician assistants and clinical nurse specialists will now be reimbursed. Payment will be 80 percent of the allowable fee to physicians. The non-physician providers must also be authorized under state law to perform the procedure.   The American Medical Associations specialty society relative value [...]

Reader Question: Dx for Postpolypectomy Syndrome   (January 2002)

Question: Patient has abdominal pain (789.00), fever (780.6), nausea (787.02) and distention (787.3). Gastroenterologist also states that the patient has postpolypectomy syndrome. Is there a specific diagnosis code for this or should I code the patients signs and symptoms?Ohio Subscriber Answer: There is no ICD-9 code for postpolypectomy syndrome, and you should report the patients signs and symptoms instead.

Reader Question: Acute, Chronic and Unspecified Esophagitis   (January 2002)

Question: An EGD with biopsy (43239) comes back with a finding of acute and chronic esophagitis. ICD-9 2002 has a new code for acute esophagitis, 530.12. The ICD-9 alphabetic index tells me to use 530.10 for chronic esophagitis. When I look up that code in the tabular list, however, there is no mention of chronic esophagitis; the real description is esophagitis, unspecified. This seems to contradict the finding of acute esophagitis. Any suggestions on which [...]

CPT^® 2002 Revises Control-of-Bleeding, Adds Emerging-Tech Codes   (December 2001)

Revisions to the control-of-bleeding and dilation codes are among the significant changes of interest to gastroenterologists in CPT 2002. While most of the gastroenterology changes are fairly minor, they are part of a move toward compliance with the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and a gradual transition to CPT-5, the next generation of current procedural terminology.  “There aren’t as many code changes for gastroenterology as there were last [...]

Prolonged Services Codes Are Alternative to Timed E/M Visits   (December 2001)

The codes for prolonged services with direct patient contact (99354-99357) can be used to bill for E/M sessions that extend at least 30 minutes beyond the time limits established by CPT. An article in the July 2001 Gastroenterology Coding Alert, “Boost Level of Follow-Up E/M With Time as the Key Component,” recommended that gastroenterologists use time as the key component when determining the level of a follow-up office visit when more than 50 percent of [...]

You Be the Coder: Physician Supervision During Manometry   (December 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Does a physician have to be present when an esophageal manometry test (91010) is performed? I heard that Medicare has a new policy on this. Colorado Subscriber

 Answer: Medicare issued a new policy on the level of physician supervision required for esophageal manometry and other gastrointestinal tests performed in an office setting. Effective July 1, 2001, [...]