Physician Practice

G codes add confusion to 2015 CPT digestive system changes

Physician Practice Insider, April 7, 2015

The 2015 CPT® Manual includes changes to the Digestive section to align codes for the lower gastrointestinal (GI) system with concepts introduced last year for the upper GI, but the most confusing aspect for physician coders may be the requirements for reporting the new codes to Medicare.

Instead of providing work relative value units (RVU) and accepting the new and revised 2015 endoscopy codes, CMS created new HCPCS G codes that map to the 2014 codes and retain the values set in 2014.

"We're getting a lot of questions from coders about how and when to use these codes, and some are not even aware of the new G codes," says Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, CCS, vice president of member and certification development for AAPC in Salt Lake City.

In the 2015 Medicare Physician Fee Schedule (MPFS) final rule, CMS said that stakeholders requested the agency wait until 2016 to valuate these codes for frequently performed procedures so stakeholders could comment on their values.

"Just because a CPT code is introduced does not mean Medicare will recognize it or valuate it," says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding for HCPro, a division of BLR, in Danvers, Massachusetts. She recommends coders check with commercial payers as well, to determine how they have decided to handle the new codes.

CMS noted previously that it plans to change how moderate sedation is reported and valued, and many of the endoscopy procedures include it. Stakeholders suggested the GI endoscopy codes should be revalued in conjunction with any changes to moderate sedation for 2016, according to CMS in the MPFS final rule.

Physicians should report the G codes for Medicare and Medicare Advantage plans, while hospitals and ambulatory surgery centers should report the 2015 CPT, regardless of payer, according to the American Gastroenterology Association (AGA).

"If you have a CPT endoscopy code that hasn't changed from 2014 to 2015, nothing's changed and you're going to report them like you have," McCall says. "If you have an endoscopy code that has been revised or deleted from 2014 to 2015, then you're going to have to report the new G codes to Medicare."

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