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 Our physician is documenting A 13 mm polyp was found in the ascending colon. The polyp was sessile. The polyp was removed with a saline injection-lift technique using a hot snare. Resection and retrieval were complete. All three need to be documented, if not: Use individual components 7

8 8

9 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. 9

10 Answer Modifier PT does not apply as it is not a screening colonoscopy. In this case you would resubmit without the PT modifier. Although a screening is done in the absence of signs or symptoms once the patient has a diagnosis of polyps, whether a sessile serrated adenoma, adenma or hyperplastic, follow ups are surveillance, not screening. If the patient has a history of polyps, is now returning for a follow-up exam and is otherwise asymptomatic, tehn the exam is a surveillance colonoscopy. If the previous polyps were benign, tehn we code z personal history of polyps. 10

11 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? 11

12 Answer According to Medicare guidelines, if you perform an incomplete colonoscopy and you plan to repeat it, you would append modifier -53. Medicare rules for colonoscopy differ from the AMA rules, particularly with regard to incomplete colonoscopies. For a Medicare patient undergoing a screening colonoscopy. If the surgeon is able to advance the scope past the splenic flexure, consider the colonoscopy complete and report the appropriate code such as a screening code G0105 colorectal cancer screening; colonoscopy on individual high risk or G0121 colorectal cancer screening colonscopy on individual not meeting criteria for high risk depending on the patients risk factors with no modifier appended. In such a case medicare will pay the standard reimbursement rate for the coded procedure. odifier 52. Some payers follow different modifier rules. 12

13 Answer continued Medicare guidance for incomplete, if the physician preps the patient for a screening colonoscopy but cannot advance the scope past the splenic flexure due to obstruction, patient discomfort, etc use modifier 53 per CMS. When a covered colonoscopy is attempted but cannot be completed because of extenuating circumstances Medicare will pay for the interrupted colonoscopy at a rate consistent with that of a flex sig as long as coverage conditions are met for the incomplete procedure. One week after an attempted but unsuccessful screening exam, a high-risk patient returns for a second attempt, this one is successful past the splenic flexure. Initial would be reported G and we will get flex sig payment. Medicare rules state we get paid in full for he second exam. For an incomplete colonoscopy with full prep for a colonoscopy use a colonoscopy code with the m 13

14 Top Asked Questions Colonoscopy done for evaluation of iron deficiency anemia. The scope was passed beyond the splenic flexure, but not to the cecum or colon-small intestine anastomosis, because of inadequate prep. The physician indicates that the patient will be brought back for repeat procedure after re-prep tomorrow. 14

15 Answer Since the exam was incomplete for unforeseen circumstances, and was a diagnostic (not therapeutic) procedure, the patient is returning for complete colonoscopy and modifier 53 should be added to

16 Top Asked Questions A 70-year-old male is undergoing high-risk screening due to personal history of transverse colon cancer. The scope was advanced to the ascending colon, but the prep was incomplete and the examination could not be completed. The physician plans to try again after repeat prep. 16

17 Answer Modifier 53 would be added to for the incomplete first attempt. If the second attempt is complete and no lesions are biopsied or removed, report G0105 for the subsequent procedure. 17

18 Top Asked Questions A 65-year-old female, asymptomatic, is undergoing screening colonoscopy. The scope was advanced to the cecum, but prep is incomplete and visibility was not acceptable, thus adequate screening could not be completed. The patient is returning for reevaluation after repeat prep. 18

19 Answer A 65-year-old female, asymptomatic, is undergoing screening colonoscopy. The scope was advanced to the cecum, but prep is incomplete and visibility was not acceptable, thus adequate screening could not be completed. The patient is returning for re-evaluation after repeat prep. Modifier 53 would be added to for the incomplete first attempt. If the second attempt is complete and no lesions are biopsied or removed, report G0121 for the subsequent procedure. 19

20 Top Asked Questions A 54-year-old is undergoing screening colonoscopy. Obstructing mass found in the transverse colon, which prevented examination of the right colon. Biopsies were taken. 20

21 Answer Modifier 52 and either modifier PT (if a Medicare beneficiary) or 33 (if a commercial, Medicaid, Tricare patient) would be added to This indicates the procedure was intended to be screening. However, once a biopsy was performed, it became therapeutic. Since it was also incomplete, modifier 52 is reported. 21

22 2017 CPT Updates

23 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] 23

24 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] 24

25 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] 25

26 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] 26

27 2017 ICD-10-CM Coding Updates

28 Digestive Periodontitis 28

29 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 29

30 Necrotizing enterocolitis NEC Symptoms include: Staging of NEC uses the Bell Stage classification: Abdominal bloating Blood in the stool Diarrhea Feeding problems Lack of energy Unstable body temperature Unstable breathing, heart rate, or blood pressure Vomiting 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 30

31 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 31

32 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 32

33 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 33

34 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 34

35 CEU Code ATL221 35