Lower gastrointestinal endoscopy claims have to show medical necessity if they are to be reimbursed without fail. This means that the appropriate ICD-9 codes will have to be reported. Usually, Medicare carrier websites publish these codes for GI procedures. Therefore when coding for lower GI procedures, payer-specific coding becomes very important.
Lower Gastrointestinal Endoscopic Procedure Codes
Procedure – CPT Code
Diagnostic sigmoidoscopy – 45330
Sigmoidoscopy with biopsy – 45331
Sigmoidoscopy with foreign body removal – 45332
Sigmoidoscopy with electrocautery removal of tumor – 45333
Sigmoidoscopy with control of bleeding – 45334
Sigmoidoscopy with snare removal of rumor or polyp – 45338
Diagnostic colonoscopy – 45378
Colonoscopy with removal of foreign body – 45379
Colonoscopy with biopsy – 45380
Colonoscopy with control of bleeding – 45382
Colonoscopy with electrocautery removal of tumor – 45384
Colonoscopy with snare removal of tumor or polyp – 45385
Factors to Take into Account When Reporting Lower GI Procedures
Lower GI procedures have to be reported taking into account the scope insertion site and the services the physicians provided during the endoscopy. The length of scope insertion, the approach method, the doctor’s services, and the diagnosis are important factors to note when coding for lower GI procedures. When these are clear in the claims, there is a better chance for accurate reimbursement.
Since there are four distinct code sets for lower endoscopies, it is important to record the extent of scope insertion.
· Choose from the anoscopy code set 46600 to 46615 – Anus (for up to 5 cm insertion)
· Proctosigmoidoscopy codes 45300 to 45321 – Anal canal, rectum and the sigmoid colon (6cm – 25 cm)
· Choose a code from the sigmoidoscopy set 45330 to 45339 – Entire rectum, sigmoid colon, and/or performs an exam of a portion of the descending colon up to the splenic flexure (26 cm to 60 cm)
· Choose from the colonoscopy code set 45378 – 45385 – Entire colon, from the rectum to the cecum (more than 60 cm), and/or the last portion of the small intestine
Once the endoscopic procedure has been correctly identified, the next step is to verify whether the service provided is therapeutic or diagnostic. For diagnostic services, the first code in the appropriate lower GI endoscopy family has to be reported. Therapeutic services have to be reported using the correct therapeutic lower GI endoscopy codes you find below the diagnostic code in each endoscopy family. Care has to be taken to arrive at the proper code by checking the operative notes the physician has provided.
Experienced Medical Billing and Coding Firm Can Assist in Accurate Coding
Coding for gastrointestinal procedures is rather complex and requires in-depth knowledge regarding the diagnostic and procedure codes. Only then can each procedure be coded accurately and reimbursement ensured. Another crucial factor is payer-specific coding. You have to know the services that are eligible for reimbursement with individual payers. Established medical billing firms have expert coding and billing staff, state-of-the-art software and excellent quality assurance to make sure that your claims are flawless and submitted on time.