Health Information Management

Do you find CPT digestive system changes hard to stomach?

APCs Insider, June 13, 2014

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No section of the 2014 CPT® Manual included more changes than the digestive system (codes 40490–49999), with dozens of new, revised, and deleted codes, as well as guideline updates.
The AMA made more than 70 code changes in the three subsections of the endoscopy section (43191–43273) alone:
  • Esophagoscopy (43191–43233): 13 new, 14 revised, two deleted codes
  • Esophagogastroduodenoscopy (EGD) (43235–43259): five new, 21 revised, two deleted codes
  • Endoscopic retrograde cholangiopancreatography (ERCP) (43260–43273): five new, four revised, five deleted codes
The digestive system section changes incorporate new technologies and procedures and updated descriptions to better align with ICD-10-CM.
For example, the guidelines now specify the anatomic structures that are included in an esophagoscopy, in order to assist with the more specific ICD-10-CM codes. According to the CPT Manual:
Esophagoscopy has been specifically defined to include examination from the cricopharyngeus muscle (upper esophageal sphincter) up to and including the gastroesophageal junction and may include examination of the proximal region of the stomach via retroflexion when performed.
If the scope is inserted and the physician just takes a quick look into the stomach, it's still considered an esophagoscopy. In the EGD subsection, the guidelines refer coders back to the esophagoscopy codes if the physician examines only the esophagus, up to the proximal region of the stomach.
A parenthetical reference also directs coders toward codes related to examinations for surgically altered stomachs where the jejunum is examined distal to the anastomosis (e.g., gastric bypass, Billroth II). The AMA made this update to accommodate the number of patients now undergoing gastric bypass surgery.
To better understand the numerous changes for gastrointestinal procedures—including services that are now bundled and the impact on physician documentation—we've teamed with experts and AHIMA-approved ICD-10-CM/PCS trainers Denise Williams, RN, CPC-H, and Steven Espinosa, CCS, for an upcoming webcast.
In addition to reviewing the changes, Denise and Steven will provide advice on updating templates and performing self-audits for these services, as well as answer your questions live.
The webcast, Mastering Gastrointestinal Code Changes, will start at 1 p.m. (Eastern) Wednesday, June 18. For more information, visit the HCPro Healthcare Marketplace.

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