2016 Quick Reference Coding Chart

Transcription

1 43197 Trans nasal esophagoscopy Biospy Trans Nasal Esophagoscopy Esophagoscopy Esophagoscopy Includes collection of specimen(s) by brushing or washing, when performed Submucosal injection Not separately reportable with varix injection, endoscopic mucosal resection or control of bleeding described by 43204, 43211, for the same lesion Biopsy Do not report in conjunction with for the same lesion Variceal injection Do not report in conjunction with 43201, for the same lesion Band ligation Do not report in conjunction with for the same lesion Optical endomicroscopy Do not report in conjunction with Esophagogastric fundoplasty New code for esophagogastric fundoplication, partial or complete. Includes duodenoscopy when performed. Do not report with 43197, 43200, Foreign body removal If fluroscopic guidance performed, use Hot biopsy or cautery Snare lesion removal Do not report in conjunction with for the same lesion Endoscopic mucosal resection Report only when injection, banding AND lesion removal is performed. Do not report in conjunction with 43201, 43205, for the same lesion Stent placement Stent placement includes dilation and guidewire passage. Do not report with codes 43220, 43226, If fluroscopic guidance performed, use Dilation with balloon <30mm If fluroscopic guidance performed, use For dilation without endoscopic visualization, see 43450, Retrograde dilation Do not report in conjunction with 74360, 76000, Dilation with balloon 30mm Includes imaging when performed. Do not report in conjunction with 74360, 76000, Guide wire insertion and dilation Do not report in conjunction with for the same lesion. Do not report in conjunction with 43212, If fluoroscopic guidance performed, use Control of bleeding, any method Do not report when bleeding occurs as a result of an endoscopic procedure. Do not report in conjunction with 43201, 43204, for the same lesion Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with 43220, for the same lesion Endoscopic ultrasound (EUS) Do not report in conjunction with 43232, Endoscopic ultrasound (EUS) with fine needle Do not report in conjunction with 43231, 76942, aspiration (FNA) Unlisted procedure, esophagus Unlisted procedure of the esophagus EGD Includes collection of specimen(s) by brushing or washing, when performed Submucosal injection Not separately reportable with varix injection, endoscopic mucosal resection or control of bleeding described by 43243, 43254, for the same lesion Endoscopic ultrasound (EUS), limited Report if EUS performed is limited to esophagus, stomach OR duodenum. Do not report more than once per session Endoscopic ultrasound (EUS), limited, with fineneedle aspiration (FNA) report more than once per session. Report if EUS performed is limited to esophagus, stomach OR duodenum. Do not Biopsy Pseudocyst drainage Includes placement of drain, stent, transmural needle aspiration and EUS. Not separately reportable with 43237, 43238, 43242, 43253, Tube or catheter insertion EGD Jan. 6, 1

2 EGD Endoscopic ultrasound (EUS) with fine needle Report only if EUS of esophagus, stomach AND duodenum is performed. aspiration (FNA) Sclerosis of varices Not separately reportable with submucosal injection and control of bleeding described by 43236, for the same lesion Band ligation Not separately reportable with endoscopic mucosal resection or control of bleeding described by 43254, for the same lesion Stricture dilation Use to report dilation of gastric, duodenal stricture. Not separately reportable with tumor ablation, stent placement described by 43266, Gastrostomy tube placement Foreign body removal Guide wire insertion and dilation Use to report dilation of esophageal stricture. Not separately reportable with stent placement, ablation described by 43266, Dilation with balloon <30mm Not separately reportable with ablation, stent placement described by 43270, Dilation with balloon 30mm Includes imaging, not separately reportable with 74360, 76000, Hot biopsy or bipolar cautery Snare lesion removal Not separately reportable with endoscopic mucosal resection described by for the same lesion Optical endomicroscopy Ultrasound guided injection (e.g., fiducial marker, Not separately reportable with 43237, 43238, 43240, 43242, 43259, 76942, celiac axis injection) Endoscopic mucosal resection Report only when injection, banding AND lesion removal performed. Do not report in conjunction with 43236, 43239, or for same lesion Control of bleeding Do not report in conjunction with 43236, 43243, for same lesion Stent placement Stent placement includes dilation and guidewire passage. Do not report in conjunction with 43240, 43241, 43245, 43248, for same lesion Thermal therapy to lower esophageal sphincter For ablation, see 43229, Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with 43248, for the same lesion Endoscopic ultrasound (EUS) Report only if EUS of esophagus, stomach AND duodenum performed. Do not report in conjunction with 43237, 43240, 43242, 43253, Unlisted procedure, stomach Unlisted procedure of the stomach ERCP ERCP Includes collection of specimen(s) by brushing or washing, when performed Biopsy Sphincterotomy/papillotomy May report if performed in addition to 43261, 43263, 43264, 43265, 43275, Do not report in conjunction with for stent placement or for stent exchange in the same location. Do not report in conjunction with Sphincter of Oddi pressure measurement Do not report more than once per session Calculi/debris removal Includes removal of debris. Do not report if no calculi or debris found. Do not report in conjunction with stone destruction (lithotripsy) described by Lithotripsy Do not report in conjunction with Stent placement into biliary or pancreatic duct Do not report in conjunction with 43262, 43275, 43276, in the same duct Foreign body/stent removal Do not report in conjunction with 43274, Removal and exchange of stent Do not report in conjunction with Do not report in conjunction with 43262, in the same duct. Jan. 6, 2

3 43277 Dilation with sphincteroplasty, sphincterotomy Do not report in conjunction with for the same lesion. Do not report in conjunction with Do not report for incidental dilation performed with 43264, Do not report in conjunction with 43274, in the same duct Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with for the same lesion Endoscopic papilla cannulation, visualization of Report once per procedure. pancreatic/ common bile duct(s) Unlisted procedure, liver Unlisted procedure of the liver Unlisted procedure, biliary tree Unlisted procedure of the biliary tree Unlisted procedure, pancreas Unlisted procedure of the pancreas Esophagus dilation, unguided sound or bougie For radiological supervision and interpretation, use Dilation of esophagus over guide wire For radiological supervision and interpretation, use Esophagogastric tamponade, with balloon (Sengstaken) Tubes Naso or oro gastric tube placement, requiring Do not report in conjunction with 76000, physician's skill and fluoroscopic placement Gastric intubation and aspiration(s), therapeutic, necessitating physician's skill Gastric intubation and aspiration, diagnostic, single specimen Gastric intubation and aspiration, collection of multiple specimens, includes drug administration Duodenal intubation and aspiration, diagnostic, single specimen Duodenal intubation and aspiration, collection of multiple speciments, includes drug administration Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance Repositioning of naso or oro gastric feeding tube, through the duodenum for enteric nutrition Do not report in conjunction with 44500, If imaging guidance is performed, use Introduction of long gastrointestinal tube (e.g. For radiological supervision and interpretation, use Miller Abbott) Endoscopy, Small Intestine Not including ileum Small intestinal enteroscopy, not including ileum Biopsy Foreign body removal Snare polypectomy Hot biopsy Control of bleeding Ablation Stent placement Percutaneous jejunostomy tube Conversion of PEG to PEJ ERCP Esophageal Manipulation Jan. 6, 3

4 44376 Small intestinal enteroscopy, including ileum Biopsy Control of bleeding Stent placement Endoscopy, Small Intestine Including ileum Ileoscopy Ileoscopy Includes collection of specimen(s) by brushing or washing, when performed Biopsy Balloon dilation Report new code with modifier 59 for each additional stricture dilated. Do not report in conjunction with for the same lesion. Use if fluoroscopic guidance is performed Stent placement Stent placement includes dilation and guidewire passage. Not separately reportable with Use if fluoroscopic guidance is performed. Pouchoscopy Pouchoscopy Terminology updated to include Kock pouch and ileal reservoir [S or J] as examples. Includes collection of specimen(s) by brushing or washing, when performed Biopsy Changes in colonoscopy guidelines section Colonoscopy through Stoma Colonoscopy through stoma is now defined as the examination of the colon, from the colostomy stoma to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis. When performing an endoscopic procedure on a patient who is scheduled and prepared for a colonoscopy through stoma, if the physician is unable to advance the colonoscope to the cecum or colonsmall intestine anastomosis due to unforeseen circumstances, report with modifier 53 with appropriate documentation. For therapeutic exams that do not reach the colon small intestine anastomosis, report the appropriate colonoscopy through stoma code with modifier 52 with appropriate documentation Colonoscopy through stoma Includes collection of specimen(s) by brushing or washing, when performed Biopsy Foreign body removal Use if fluoroscopic guidance performed Control of bleeding Do not report in conjunction with for same lesion Hot biopsy Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with for the same lesion Snare Do not report in conjunction with 44403, endoscopic mucosal resection, for the same lesion Stent placement Stent placement includes dilation and guidewire passage. Do not report in conjunction with Use if fluoroscopic guidance is performed Endoscopic mucosal resection (EMR) Report only when injection, banding AND lesion removal performed. Do note report in conjunction with biopsy, submucosal injection or snare described by 44389, 44394, for the same lesion Submucosal injection Do not report in conjunction with 44391, for the same lesion Balloon dilation Do not report in conjunction with 44401, Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Use if fluoroscopic guidance is performed Endoscopic ultrasound (EUS) Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Do not report in conjunction with or Report only once per session. Jan. 6, 4

5 Colonoscopy through Stoma Endoscopic ultrasound (EUS) with FNA Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Do not report in conjunction with 44406, 76942, Report only once per session Decompression Includes placement of decompression tube when performed. Report only once per session Unlisted procedure, small intestine Unlisted procedure of the small intestine. Flexible Sigmoidoscopy Flexible sigmoidoscopy Includes collection of specimen(s) by brushing or washing, when performed Biopsy Do not report in conjunction with for the same lesion Foreign body removal Use if fluoroscopic guidance is performed Hot biopsy Control of bleeding Do not report in conjunction with 45335, for same lesion. Flexible Sigmoidoscopy Submucosal injection Do not report in conjunction with 45334, for the same lesion Decompression Includes placement of decompression tube when performed. Report only once per session Snare Do not report in conjunction with for the same lesion Ablation Ablation includes dilation and guidewire passage, if performed. Do not report in conjunction with for the same lesion Dilation Do not report in conjunction with 45346, Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Use if fluoroscopic guidance is performed Endoscopic ultrasound (EUS) Do not report in conjunction with 45342, 76872, Report only once per session Endoscopic ultrasound (EUS) with FNA Do not report in conjunction with 45341, 76872, 76942, Report only once per session Stent placement Stent placement includes dilation and guidewire passage, if performed. Do not report in conjunction with Use if fluoroscopic guidance performed Endoscopic mucusal resection (EMR) Report only when injection, banding AND lesion removal performed. Do not report in conjunction with 45331, 45335, 45338, for the same lesion Band ligation Do not report in conjunction with for the same lesion. Do not report in conjunction with 45349, To report control of active bleeding with band ligation, use Colonoscopy Changes in definition of colonoscopy Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis. When performing a diagnostic or screening endoscopic procedure on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon small intestine anastomosis, report with modifier 53 and provide appropriate documentation. For therapeutic colonoscopy, report modifier 52 and provide appropriate documentation Colonscopy Includes collection of specimen(s) by brushing or washing, when performed Foreign body Use if fluoroscopic guidance is performed Biopsy Do not report in conjunction with for the same lesion Submucosal injection Do not report in conjunction with 45382, for the same lesion Control of bleeding Do not report in conjunction with 45381, for the same lesion. Hemorrhoids described by 45381, for same lesion. Jan. 6, 5

6 45388 Ablation Ablation includes dilation and guidewire passage, when performed. Do not report in conjunction with for the same lesion Hot biopsy Snare Do not report in conjunction with for the same lesion Dilation Do not report in conjunction with 45388, Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Use if fluoroscopic guidance performed Stent placement Stent placement includes dilation and guidewire passage, when performed. Do not report in conjunction with Use if fluoroscopic guidance performed Endoscopic ultrasound (EUS) Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Report only once per session. Do not report in conjunction with 45392, 76872, Endoscopic ultrasound (EUS) with FNA Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Do not report in conjunction with 45381, 76872, 76942, Report only once per session Endoscopic mucosal resection (EMR) Report only when injection, banding AND lesion removal performed. Do not report in conjunction with 45380, 45381, 45385, for the same lesion Decompression Includes placement of decompression tube placement when performed. Report only once per session Band ligation Do not report in conjunction with for the same lesion. Do not report in conjunction with 45390, To report control of active bleeding with band ligation, use Do not report more than once per session Unlisted procedure, colon Unlisted procedure of the colon Unlisted procedure, rectum Unlisted procedure of the rectum. Anus Hemorrhoidectomy, internal, by rubber band Do not report in conjunction with 45350, ligation Anoscopy, diagnostic Includes collection of specimen(s) by brushing or washing, when performed Destruction of internal hemorrhoid(s) by thermal energy Unlisted procedure, anus Abdominal Procedures Biopsy of liver, needle, percutaneous Abdominal paracentesis, without imaging guidance Abdominal Procedures With imaging guidance Do not report in conjunction with 76942, 77002, 77012, Electronic analysis of implanted neurostimulatory pulse generator system; intraoperative, with programming Subsequent, without reprogramming Subsequent, with reprogramming Helicobacter pylori urea breath test, C 14, acquisition for analysis Analysis Helicobacter pylori, breath test analysis, C Drug administration Colonoscopy Gastric Neurostimulators Gastrointestinal Diagnostic Procedures Jan. 6, 6

7 Gastrointestinal Diagnostic Procedures Esophageal motility Esophageal motility, with stimulation or Do not report more than once per session. perfusion Gastric motility Do not report in conjunction with Duodenal motility Do not report in conjunction with Esophagus, acid perfusion Esophagus, gastroesophageal reflux test, with nasal catheter ph electrode(s) placement Esophagus, gastroesophageal reflux test, with mucosal attached telemetry ph electrode placement Esophageal function test, with nasal catheter impedance electrode(s) placement Esophageal function test, with nasal catheter impedance electrode(s) placement, prolonged Esophageal balloon distension study Revised to 'with provocation, when performed.' Breath hydrogen or methane test Report once for each administered challenge Gastrointestinal tract imaging, intraluminal, Append modifier 52 if ileum not visualized. Do not report in conjunction with esophagus through ileum Gastrointestinal tract imaging, intraluminal, Do not report in conjunction with esophagus Gastrointestinal transit and pressure Do not report in conjunction with 91020, 91022, measurement, stomach through colon, wireless capsule Colon motility, including provocation tests if Do not report in conjunction with 91120, performed Rectal sensation, tone and compliance test Do not report in conjunction with Anorectal manometry Do not report in conjunction with Electrogastrography (EGG), diagnostic EGG, with provocative testing Liver elastography Unlisted diagnostic gastroenterology procedure Photodynamic Therapy Photodynamic therapy; first 30 minutes Report with modifier 52 for service of less than 23 minutes Each additional 15 minutes Infusion Therapy Hydration, initial, minutes Each additional hour Report for intervals of greater than 30 minutes beyond one hour increments Intravenous infusion, up to 1 hour Each additional hour Report for intervals of greater than 30 minutes beyond one hour increments Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscular Intravenous push, single or initial substance/drug Each additional sequential intravenous push of a new substance/drug Chemotherapy administration, intravenous infusion, up to one hour Infusion Therapy Jan. 6, 7

8 96415 Each additional hour Report for intervals of greater than 30 minutes beyond one hour increments Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry Biofeedback Jan. 6, 8