GI Coding Updates. Rhonda Buckholtz, CPC, CPCI, CPMS, CRC, CDEO, CHPSE, CGSC, COBGC, CENTC, CPEDC

Transcription

1 GI Coding Updates Rhonda Buckholtz, CPC, CPCI, CPMS, CRC, CDEO, CHPSE, CGSC, COBGC, CENTC, CPEDC Copyright/Disclaimer 2014 AAPC text

2 CPT copyright 2016 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. The responsibility for the content of any National Correct Coding Policy included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product. 2

3 Agenda Top GI coding questions What the new CPT codes are and how to apply them How the new changes in I10 will apply Key terms to look in documentation for correct assignment

4 Top GI Coding Questions

5 Top Questions Asked We are trying to get coding information for billing for an injection of epinephrine, in the rectum, applied for hemostasis. A 20ml saline injection for saline pillow, polypectomy performed using a hot snare. And then ablation using a soft coag current at 80 watts. All done in the rectum. Can all three be billed at the same time? We are billing 45388, 45381,

6 Endoscopic Mucosal Resection (EMR) Includes cap-assisted or ligation-assisted (banding) removal of a lesion with injection-assisted snare removal techniques Requires the lift technique to create a space beneath the lesion Use of a specialized device to isolate the tissue Include: Submucosal injection to lift the lesion Demarcation of the lesion Endoscopic snare resection 6

7 EMR All three need to be documented, if not: Use individual components 7

8 Top Asked Questions How do I bill for colonoscopy done for surveillance for history of ulcerative colitis? We billed it as a with a PT modifier and Z Medicare denied. 8

9 Top Asked Questions We are having a debate in our office due to the ambiguity of the explanation of coding of colonoscopies. In the decision tree it states that if it does not reach the splenic flexure it should be coded as a FS and implies that only if it passes the splenic flexure but does not reach the cecum should the modifier -53 modifier be used. But what if a colonoscopy was panned but didn't reach the splenic flexure for whatever reason and we want to repeat it? Wouldn t we want to still bill the colonoscopy code with the -53 modifier? 9

10 2017 CPT Updates

11 Moderate Sedation Services Provided by the Same Physician for GI Endoscopy GMMM1 Moderate sedation services provided by the same physician or other qualified health-care professional performing a gastrointestinal endoscopic service (excluding biliary procedures) that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older. [0.10 Proposed physician work RVUs] 11

12 Moderate Sedation Services Provided by the Same Physician Moderate sedation services provided by the same physician or other qualified health-care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient younger than 5 years of age. [0.50 Proposed physician work RVUs] 12

13 Moderate Sedation Services Provided by the Same Physician initial 15 minutes of intraservice time, patient age 5 years or older Moderate sedation services provided by the same physician or other qualified health-care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; initial 15 minutes of intra-service time, patient age 5 years or older [0.25 Proposed physician work RVUs] 13

14 Moderate Sedation Services Provided by the Same Physician Each addition 15 minutes intraservice time Moderate sedation services provided by the same physician or other qualified health-care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient s level of consciousness and physiological status; each additional 15 minutes of intraservice time (List separately in addition to code for primary service). [0.00 Proposed physician work RVUs] 14

15 2017 ICD-10-CM Coding Updates

16 Digestive Periodontitis 16

17 K Add Aggressive periodontitis, localized, slight K Add Aggressive periodontitis, localized, moderate K Add Aggressive periodontitis, localized, severe K Add Aggressive periodontitis, localized, unspecified severity K Add Aggressive periodontitis, generalized, slight K Add Aggressive periodontitis, generalized, moderate K Add Aggressive periodontitis, generalized, severe K Add Aggressive periodontitis, generalized, unspecified severity K Add Chronic periodontitis, localized, slight K Add Chronic periodontitis, localized, moderate K Add Chronic periodontitis, localized, severe K Add Chronic periodontitis, localized, unspecified severity K Add Chronic periodontitis, generalized, slight K Add Chronic periodontitis, generalized, moderate K Add Chronic periodontitis, generalized, severe 17

18 Necrotizing enterocolitis NEC Symptoms include: Abdominal bloating Blood in the stool Diarrhea Feeding problems Lack of energy Unstable body temperature Unstable breathing, heart rate, or blood pressure Vomiting Staging of NEC uses the Bell Stage classification: Stage 1 Suspected NEC Mildest of symptoms Stage 2 Proven NEC cases Signs more indicative of NEC (other gastrointestinal disorders have been ruled out) Abdominal distention is marked Persistent occult or frank blood in stool may be present Stage 3 Advanced NEC cases showing stage 1 and 2 Shows a deterioration of vital signs Evidence of septic shock, marked gastrointestinal bleeding 18

19 Necrotizing enterocolitis NEC K55.30 Add Necrotizing enterocolitis, unspecified K55.31 Add Stage 1 necrotizing enterocolitis K55.32 Add Stage 2 necrotizing enterocolitis K55.33 Add Stage 3 necrotizing enterocolitis Documentation concepts include: Type Stage 19

20 Necrotizing enterocolitis NEC Other additions K58.1 Add Irritable bowel syndrome with constipation K58.2 Add Mixed irritable bowel syndrome K58.8 Add Other irritable bowel syndrome K59.03 Add Drug induced constipation K59.04 Add Chronic idiopathic constipation K59.31 Add Toxic megacolon K59.39 Add Other megacolon K85.00 Add Idiopathic acute pancreatitis without necrosis or infection K85.01 Add Idiopathic acute pancreatitis with uninfected necrosis K85.02 Add Idiopathic acute pancreatitis with infected necrosis K85.10 Add Biliary acute pancreatitis without necrosis or infection K85.11 Add Biliary acute pancreatitis with uninfected necrosis 20

21 Necrotizing enterocolitis NEC Deletions include codes that were expanded with additions: K04.0 Delete Pulpitis K05.21 Delete Aggressive periodontitis, localized K05.22 Delete Aggressive periodontitis, generalized K05.31 Delete Chronic periodontitis, localized K05.32 Delete Chronic periodontitis, generalized K08.8 Delete Other specified disorders of teeth and supporting structures K52.2 Delete Allergic and dietetic gastroenteritis and colitis K55.0 Delete Acute vascular disorders of intestine K59.3 Delete Megacolon, not elsewhere classified K85.0 Delete Idiopathic acute pancreatitis K85.1 Delete Biliary acute pancreatitis K85.2 Delete Alcohol induced acute pancreatitis K85.3 Delete Drug induced acute pancreatitis K85.8 Delete Other acute pancreatitis K85.9 Delete Acute pancreatitis, unspecified K86.8 Delete Other specified diseases of pancreas 21

22 Necrotizing enterocolitis NEC Revised codes include: K91.61 Revise from Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive system procedure K Revise from K Revise from Postprocedural hemorrhage and hematoma of a digestive system organ or structure following a digestive system procedure Postprocedural hemorrhage and hematoma of a digestive system organ or structure following other procedure K91.61 Revise to K Revise to K Revise to Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive system procedure Postprocedural hemorrhage of a digestive system organ or structure following a digestive system procedure Postprocedural hemorrhage of a digestive system organ or structure following other procedure 22