CPT code 0226T, 0227T, 91200 , 3775F,

2015 New Update on GI billing Codes

Other Changes
Category I Codes

HIGH RESOLUTION ANOSCOPY

• Category III codes 0226T and 0227T were deleted and replaced with two new Category I codes for high-resolution anoscopy (HRA). Code 46601 describes a diagnostic HRA with collection of specimens by brushing or washing, when performed. Code 46607 describes HRA with single or multiple biopsies. Both codes include chemical agent enhancement and operating microscope or colposcope, if used. Code 69990 cannot be reported in conjunction with these codes. 

LIVER ELASTOGRAPHY

• New code 91200 was added for liver elastography performed via mechanically-induced shear wave technique, such as vibration. The code includes interpretation and report, but not imaging. The code describes liver fibrosis evaluation, such as Fibroscan®, Philips® shear wave ultrasound elastography and other hepatic shear wave technologies. If performing ultrasound with liver elastography, report using 76700, Ultrasound, abdominal, real time imaging documentation, complete, OR 76705, Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow up), AND 0346T, Ultrasound, elastography (list separately in addition to code for primary procedure).

Care Management Services
The Complex Chronic Care Coordination Services section has been renamed Care Management Services. The guidelines section was completely revised with the addition of two new subsections, Chronic Care Management Services and Complex Chronic Care Management Services, and the deletion of 99488 for face-to-face visits. Code 99488 describing chronic care management with face-to-face visits has been deleted in 2015 because face-to-face visits are no longer a requirement of care management services. To report one or more face-to-face visits, use the appropriate evaluation and management (E/M) code.

The new Chronic Care Management Services subsection includes guidelines for new code 99490 clarifying that this code is reported for patients receiving at least 20 minutes of chronic care management per calendar month. Service of less than 20 minutes per calendar month is not reported separately.

The new Complex Chronic Care Management Services subsection includes guidelines for revised codes 99478 and 99489 that describe at least 60 minutes of complex chronic care management services. It includes information on identification of patients receiving complex care and examples of typical patients. Service of less than 60 minutes per calendar month is not reported separately. Add-on code 99498 cannot be reported for less than 30 minutes of service in addition to the initial 60 minutes during a calendar month.

Category II Codes

• Category II codes are a set of supplemental tracking codes for performance measurement. The codes are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care. The use of Category II codes is optional. They are not required for correct coding and may not be used as a substitute for Category I codes. Category II codes are released on a semi-annual basis in January and July and are published on the AMA’s website.
• Codes 3775F and 3776F were added to report detection of adenomas or other neoplasms during colonoscopy screening. Report code 3775F for detection of adenomas or other neoplasms during screening colonoscopy. Report code 3776F if no adenoma or neoplasm is found during screening colonoscopy. The codes are used with the new Screening Colonoscopy Adenoma Rate Detection measure listing within the new Screening Colonoscopy Adenoma Detection Rate (SCADR) measure set. This measure is used to determine whether or not the patient age 50 or older has had at least one adenoma or other colorectal cancer precursor detection during a screening colonoscopy. 

Medical exclusions exist for not having at least one adenoma or other colorectal cancer precursor detected. Therefore, the reporting instructions direct use of the 1P modifier in conjunction with code 3776F to identify the exclusion circumstance.

Category III Codes
Category III codes are a temporary set of codes for emerging technologies, services and procedures. The codes “sunset,” or are retired, from the CPT book after five years, if they are not accepted as Category I codes. They typically replace unlisted codes that were previously used for new procedures or services. If a Category III code describes the procedure or service performed, it must be reported. An unlisted code or less specific Category I cannot be reported in place of an active Category III code. Category III codes are released on a semi-annual basis in January and July and are published on the AMA’s website.

• Codes 0226T [high resolution anoscopy (HRA)] and 0227T (HRA with biopsy) have been deleted and replaced by Category I codes 46601 and 46607.
• New code 0355T, Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), colon, with interpretation and report, was added effective July 1, 2014, for capsule endoscopy of the colon. Do not report 0355T in conjunction with codes 91110 or 91111. 
• New code 0377T, Anoscopy with directed submucosal injection of bulking agent for fecal incontinence, was added effective Jan. 1, 2015, for anoscopy with injection of bulking agent for fecal incontinence, using products such as NASHA/Dx (Solesta®). As with all other anoscopy services, this code is reported only once per session. 

Do not report this service with code 46600, anoscopy.

G-Codes
CMS has established HCPCS code G0464 for colorectal cancer screening via stool-based DNA and fecal occult hemoglobin tests, such as Cologuard.

• G0464 Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3) NOTE: Do not bill this code with codes 82270, 82274, G0328.