DECember 2014

2015 CPT Changes

in my opinion the biggest changes for 2015 come in the form of Chapter Guidelines and parenthetical notes. These changes/clarifications would be any text that is green in color and there is no limit to the amount of green text you will find in the GI section of the CPT Manual. We have already discussed the guidelines for colonoscopies which can found in our October newsletter in case you missed that issue.

With EGD procedures, I’m often asked, “What differentiates an EGD from a push enteroscopy?” When you look at the CPT code description it reads “enteroscopy beyond second portion of duodenum, not including ileum,” so when the physician only inserts the scope to the fourth portion of the duodenum do you report an EGD code or an enteroscopy (small intestine endoscopy) code? Based on the guidelines for 2015 when the scope cannot be advanced 50cm beyond the pylorus the coder should report an EGD code and when the scope is passed at least 50cm beyond the pylorus then the coder should report an enteroscopy code.

My recommendation is to alert your physicians to include documentation that the scope was passed at least 50cm beyond the pylorus when they are indicating that the procedure being performed is a push enteroscopy. This will avoid confusion and any need for a physician query.







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