Important Correction in 2015 CPT coding Update in GI Codes
Below is the correct version of the Decision Tree. When coding a therapeutic procedure to the cecum, bill the appropriate colonoscopy CPT code with NO modifier. Please note that the “Diagnostic Procedure” decision node can include screening or diagnostic procedures.
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Medicare Payment for Colonoscopy Procedures
In the Medicare Physician Fee Schedule (MPFS) final rule for 2015, CMS finalized a new, more transparent rate setting process. CMS will propose values for the vast majority of new, revised and potentially misvalued codes and consider public comments before establishing final values for the codes. CY 2015 will be a transition year, when updates to the colonoscopy and other lower GI endoscopy codes will be included in the CY 2016 proposed rule.
Beginning with rulemaking for CY 2017, CMS will publish the proposed values for the following calendar year during June–July, providing interested parties the opportunity to submit comments before the values are finalized. This will require CMS to address comments when the final rule is published in November.
Use of Temporary G-codes for Lower GI Endoscopy for Medicare
To implement this new initiative on transparency, CMS finalized the use of temporary G-codes to facilitate continued payment for new or modified CPT codes that do not have the benefit, due to the timing of the AMA RUC process, of first being published in the proposed rule.
Since the lower GI endoscopy CPT code set is changing for CY 2015, including the deletion of some of the CY 2014 codes, CMS is creating G-codes for 10 lower GI endoscopy services to allow practitioners to report services provided to Medicare beneficiaries in CY 2015 the same way they did in CY 2014.
For existing procedures that have new CPT code assignments in CPT 2015, CMS requires physicians to report the G-code instead of the corresponding 2015 CPT code.
Crosswalking Certain CY 2014 Lower GI Endoscopy CPT Codes to 2015 HCPCS G-Codes for Medicare During CY 2015
Below is the correct version of the Decision Tree. When coding a therapeutic procedure to the cecum, bill the appropriate colonoscopy CPT code with NO modifier. Please note that the “Diagnostic Procedure” decision node can include screening or diagnostic procedures.
Medicare Payment for Colonoscopy Procedures
In the Medicare Physician Fee Schedule (MPFS) final rule for 2015, CMS finalized a new, more transparent rate setting process. CMS will propose values for the vast majority of new, revised and potentially misvalued codes and consider public comments before establishing final values for the codes. CY 2015 will be a transition year, when updates to the colonoscopy and other lower GI endoscopy codes will be included in the CY 2016 proposed rule.
Beginning with rulemaking for CY 2017, CMS will publish the proposed values for the following calendar year during June–July, providing interested parties the opportunity to submit comments before the values are finalized. This will require CMS to address comments when the final rule is published in November.
Use of Temporary G-codes for Lower GI Endoscopy for Medicare
To implement this new initiative on transparency, CMS finalized the use of temporary G-codes to facilitate continued payment for new or modified CPT codes that do not have the benefit, due to the timing of the AMA RUC process, of first being published in the proposed rule.
Since the lower GI endoscopy CPT code set is changing for CY 2015, including the deletion of some of the CY 2014 codes, CMS is creating G-codes for 10 lower GI endoscopy services to allow practitioners to report services provided to Medicare beneficiaries in CY 2015 the same way they did in CY 2014.
For existing procedures that have new CPT code assignments in CPT 2015, CMS requires physicians to report the G-code instead of the corresponding 2015 CPT code.
Crosswalking Certain CY 2014 Lower GI Endoscopy CPT Codes to 2015 HCPCS G-Codes for Medicare During CY 2015
| CY 2014 CPT Code | CY 2015 HCPCS Code | Long Description |
| 44383 | G6018 | Ileoscopy, through stoma; with transedoscopic stent placement (includes predilation) |
| 44393 | G6019 | Colonoscopy through stoma; with ablation of tumor(s), polyp(s) or other lesion(s), not amenable to removal by hot biopsy forceps, biopolar cautery or snare techinique |
| 44397 | G6020 | Colonoscopy through stoma; with transendoscopic stent placement (includes predilation) |
| 44799 | G6021 | Unlisted procedure, intestine |
| 45339 | G6022 | Sigmoidoscopy, flexible; with ablation of tumor(s), poly(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique |
| 45345 | G6023 | Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation) |
| 45383 | G6024 | Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique |
| 45387 | G06025 | Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation) |
| 0226T | G6027 | Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed |
| 0027T | G6028 | Anoscopy, high resolution (HRA) (with magnification and chemica |