New 2015 CPT Coding Changes for Colon and Rectal Surgeons

New 2015 CPT Coding Changes for Colon and Rectal Surgeons | ASCRS

Dear ASCRS Members,

On behalf of the Healthcare Economics Committee, highlights of the 2015 CPT coding changes important to colon and rectal surgeons and a link to an ACS Bulletin article are provided below.   

Stephen Sentovich, MD
Chair, Healthcare Economics Committee

Significant coding changes will be implemented in 2015 that affect Colon and Rectal Surgeons, including changes for reporting lower GI endoscopy, high resolution anoscopy, and injection for fecal incontinence. Highlights of these changes are provided below.  For more detailed information, click HERE to download the American College of Surgeons Bulletin article on CY 2015 CPT Coding Changes.

Lower GI endoscopy

Ø Colonoscopy definition has change to "the examination of the entire colon to the cecum" (ie, not just beyond the splenic flexure).

Ø If a screening or diagnostic colonoscopy is not to the cecum, but is beyond the splenic flexure, then report 45378 with modifier 53 (discontinued procedure) appended.  For Medicare, the physician reimbursement for 45378-53 is 30% of the unmodified procedure when performed in a facility setting.

Ø If a therapeutic colonoscopy (dilatation, polypectomy, etc.) is not to the cecum, but beyond the splenic flexure, report the appropriate therapeutic colonoscopy code with modifier 52 (reduced services) appended.  For Medicare, the physician reimbursement is 50% of the unmodified procedure.

Ø Although CPT approved new and revised codes for reporting therapeutic lower endoscopy procedures, CMS has instead decided to maintain 2014 coding and payment for Medicare patients. To implement this policy, CMS assigned a status of "I" (not used for Medicare payment) to all new CPT codes. In tandem, CMS created G-codes to replicate the 2014 codes for payment. 

High resolution anoscopy

Ø New CPT Category I codes 46601 and 46607 will replace Category III codes 0226T and 0227T for high resolution anoscopy. 

Ø CMS will not recognize the new CPT codes for 2015 and instead you will need to report  G6027 and G6028 for Medicare patients. 

Injection for fecal incontinence

Ø New Category III code 0377T should be reported for injection of a bulking agent to treat fecal incontinence. It is incorrect coding to report an unlisted code for this procedure.

Ø Report the bulking agent with HCPCS code L8605 (injectable bulking agent dextranomer/ hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies).