Spring 2015  

Significant coding changes will be implemented in 2015

Dr. Stephen SentovichBy Dr. Stephen Sentovich
Chair, Healthcare Economics Committee

Significant coding changes will be implemented in 2015 that affect colon and rectal surgeons, including changes for reporting lower GI endoscopy, high resolution anoscopy, and injection for fecal incontinence. Highlights of these changes are:

Lower GI endoscopy

• Colonoscopy definition has changed to “the examination of the entire colon to the cecum” (i.e., not just beyond the splenic flexure).

• If a screening or diagnostic colonoscopy is not to the cecum, but is beyond the splenic fixture, then report 45378 with modifier 53 (discontinued procedure) appended. For Medicare, the physician reimbursement for 45378-53 is 30% of the unmodified procedure when performed in a facility setting.

• If a therapeutic colonoscopy (dilatation, polypectomy, etc.) is not to the cecum, but beyond the splenic flexure, report the appropriate therapeutic colonoscopy code with modifier 52 (reduced services) appended. For Medicare, the physician reimbursement is 50% of the unmodified procedure.

• Although CPT approved new and revised codes for reporting therapeutic lower endoscopy procedures, CMS has instead decided to maintain 2014 coding and payment for Medicare patients. To implement this policy, CMS assigned a status of “I” (not used for Medicare payment) to all new CPT codes. In tandem, CMS created G-codes to replicate the 2014 codes for payment.

High resolution anoscopy

• New CPT Category I codes 46601 and 46607 will replace Category III codes 0226T and 0227T for high resolution anoscopy.

• CMS will not recognize the new CPT codes for 2015, and instead you will need to report G6027 and G6028 for Medicare patients.

Injection for fecal incontinence

• New Category III code 0377T should be reported for injection of a bulking agent to treat fecal incontinence. It is incorrect coding to report an unlisted code for this procedure.

• Report the bulking agent with HCPCS code L8605, and the appropriate number of units for each millimeter injected should be indicated.

For more detailed information on these coding changes download the American College of Surgeons Bulletin article.

Copyright © 2015 American Society of Colon and Rectal Surgeons, All rights reserved.