Capsule colonoscopy

Friday,
November 14, 2003
Vol. 4, No. 45

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RHIT, CCS,
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University Colorado Hospital

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St. Joseph's Medical Center

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HRM

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MPA
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Asante Health System

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Today's topic

Today's question concerns capsule colonoscopy, a relatively new procedure that spurred the creation of CPT code 91110. Read on to find out more about this procedure and how to code for it.

Your APCs Weekly Monitor is a free weekly e-zine from HCPro, publisher of Briefings on APCs, the monthly newsletter devoted entirely to managing under APCs, and the newsletter, APC Answer Letter, with answers to readers' questions about coding for APCs.

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QUESTION: What is a "capsule colonoscopy," how is the procedure done, and how should we code it?

ANSWER: According to several local medical review policies (LMRPs) from Medicare Fiscal Intermediaries (FIs), capsule colonoscopy or telemetric gastrointestinal capsule imaging is a noninvasive diagnostic imaging device for viewing the gastrointestinal tract, especially the small bowel, which is not accessible through standard upper endoscopy and colonoscopy. The patient swallows a small capsule (approximately 11 x 26 mm) that transmits video pictures as peristalsis propels the capsule through the GI tract. These video images are transmitted to sensors taped to the body and stored on a portable recorder. As the capsule passes through the GI tract, the strength of the signal is used to calculate its position. The stored images are later downloaded to a computer, from which they may subsequently be viewed in real time. The capsule passes naturally from the body with the stool, and since it is disposable, is not recovered.

This test is indicated for the diagnosis of obscure gastrointestinal bleeding when the site of which has not previously been identified by upper gastrointestinal endoscopy, colonoscopy, push enteroscopy, or radiologic procedure. It may be especially helpful in the diagnosis of angioectasias of the GI tract.

There are limitations to Medicare coverage of this procedure. Check the LMRP from your FI for specific coverage circumstances and ICD-9-CM codes that support medical necessity.

Effective January 1, 2004, report this procedure as 91110, GI tract capsule endoscopy (interim APC 1508, $650.00 national unadjusted "S" status indicator). For dates of service prior to January 1, 2004, report G0262, small intestinal imaging; intraluminal, from ligament of treitz to the ileo cecal valve, includes physician interpretation and report. Payers that do not accept HCPCS Level II codes may prefer 91299, unlisted diagnostic gastroenterology procedure.

This year's Work Plan, issued by the Office of Inspector General (OIG) on October 1, has fewer coding and billing initiatives and more topics related to quality of care, accreditation, and drug reimbursement.

Click HERE to read more. The cost is $10. Medical Records Briefings subscribers have free access via their online subscriptions.

ASK THE EXPERT: Our ED physicians frequently use "musculoskeletal pain" as a final diagnosis, regardless of the pain's origin and cause (e.g., falling without any fractures, but hurting all over; involved in a collision, with generalized pain). For this situation, should we use the general symptom code 780.99, or the double code 729.1/733.90?

Click here for the EXPERT'S answer.

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.

APC Coding: Special offer on new courses from Lolita M. Jones

The courses in the "Practical APC and Advanced CPT Coding Series," created by Lolita M. Jones, RHIA, CCS, are the tools you need to manage your APC coding. All courses in the library will be updated on an ongoing basis to reflect any regulatory changes. You'll also have the opportunity to earn CE credits!

To take advantage of this special offer, or order any of the courses individually, CLICK HERE or call our customer service department at 800-650-6787. Be sure to mention Source Code EP23656A.

A new year means new CPT codes. You probably don't have time to research all of the changes slated for 2004 (there are more than 550), analyze their impact, educate staff, and implement the changes while you do your regular job. Relax, we'll do the work for you. Join us on December 2 beginning a 1 p.m. Eastern for "Mastering CPT Changes for 2004." This 90-minute live audioconference includes examples of the changes and their impact on documentation, billing, and revenue, as well as a live question-and-answer session.

To register or to learn more, CLICK HERE or call our Customer Service Team at 800/650-6787. Please mention source code EZ23501B when you call.

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