Twenty Top Tips to Triumph Over GI IR Coding in 2023 and Beyond

Is your facility experiencing the pain of IR coding obstacles? Coding for interventional radiology can be a quicksand pool of complications for many coders, especially for those who are new and may find the prospect of interventional radiology overwhelming. Coders have every right to be concerned and anxious when it comes to this area since nationally, around 30 percent of IR coding becomes lost in errors or inaccuracy, resulting in denials and lower payment, or even ominously worse…the risk of sieging audits, that ultimately jeopardize multiple divisions while throwing compliance, and finances into peril. MedLearn and our team of nationally renowned experts are here to soothe the confusion and provide actionable guidance to overcome challenges in this area. GI interventional radiology coding is an area identified by our experts as one needing careful study and review. With coders in mind, we have prepared 20 supplemental tips for success to tackle this area.

Actionable Tips for Accurate Comprehension:

1. Diagnostic imaging through an existing catheter/tube may only be coded if placement of a drainage catheter or stent is not performed through the same access.
2. Code 47542 is an add-on code that may be assigned with diagnostic cholangiography or drainage catheter placement/exchange/removal (47531– 47537 or 47451), but not with stent placement (47538–47540). Code 47542 may be reported a maximum of two times (the second with modifier -59), regardless of the number of ducts or ampulla dilated. Report code 47544 instead of code 47542 if a balloon is used to push stones, sludge, or other debris into the small intestine.
3. If performing both right- and left-sided procedures, submit each code twice. Modify as appropriate.
4. Verify and submit the appropriate procedural code depending on the area treated.
5. Diagnostic cholangiography is included in procedures involving placement of a drainage catheter or stent, do not assign code 47531 or 47532 in addition to 47533–47541 when performed through the same access.
6. Codes include all portions of the exam needed to complete the service. For example, if a patient arrives for placement of a brand new G-tube, the placing of the N-G tube into the stomach to fill it with air to allow easier entry from a “direct stick” as well as image guidance and administration of contrast to confirm adequate location/positioning are all part of the “bundled” or “collapsed” codes. Separate charges for fluoroscopy or tube checks are not allowed.
7. No specific bundled CPT® code exists to define a G-J tube placement at one patient encounter. For this scenario, assign both 49446 and 49440.
8. If converting an existing G-tube to a G-J tube at a time other than the initial placement of the G-tube, assign code 49446 only.
9. If an existing G, D, J, G-J or cecostomy (or other colonic) tube is removed and a new tube is placed from a separate access point, code this as a new (initial) tube placement.
10. If an existing G, D, J, G-J or cecostomy (or other colonic) tube is removed and replaced using the same existing tract, code this as an exchange/replacement.
11. When attempting to remove obstructive material from an existing G, D, J, G-J or cecostomy (or other colonic) tube under fluoro guidance, this service is inclusive of all other means necessary to accomplish this task. Do not unbundle into separate procedures. Code 49460 includes any/all techniques (e.g., guidewire, other mechanical, etc.) to attempt to restore patency.
12. Assign code 49465 when checking patency or position of an existing G, D, J, G-J, cecostomy (or other colonic) tube not at time of initial tube placement. Do not assign code 76000 with this code. Do not assign codes 76080 and 49424 for this procedure. Injection of contrast is considered inherent in tube changes/exchanges.
13. Report code 76000 if performed as a stand-alone procedure and fluoroscopic guidance is used.
14. Radiologic guidance utilizing CT, US or fluoroscopy can be done for various purposes. Consider the following:
    – CT-guided needle biopsy of liver;
    – US-guided cyst aspiration; and
    – Fluoro guidance for sentinel node injection.
    Guidance, unless included in the code descriptor, should not be considered part of the surgical code/service provided.
    
    The following information is found in the most recent NCCI Policy Manual for Medicare Services regarding MUEs. CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.
    
15. Use this code pair to define placement of a tube into any portion of the small bowel (i.e., duodenum, cecum, etc).
16. Previous guidance from specialty societies has instructed that endoscopy codes 47552–47556 could be used for percutaneous procedures. Bundled biliary options make this guidance obsolete. Do not report 47552–47556 for percutaneous procedures.
17. Do not bill separately for fluoroscopic guidance as this code is all-inclusive. The radiologist must define the use of fluoroscopic guidance, provide image documentation and issue a final report to submit this code. See introductory language in the Radiology Section of the CPT manual titled “Supervision and Interpretation, Imaging Guidance” for more information.
18. Report this code pair once per procedure as definition states “one or more.” This code carries a 10-day global period.
19. Use this code only when a percutaneous G-tube is placed in conjunction with a flexible transoral EGD. This procedure code reflects a procedure being performed with no imaging guidance. Do not assign code 49440 for this procedure.
20. Code 47490 is a “complete” code. It includes all types (i.e., CT, US, fluoroscopic and MRI) of imaging supervision and guidance.

These are not all the essential coding tips and rationale for interventional radiology knowledge and GI interventional radiology billing. As service volumes rebound and every dollar of reimbursement counts more than ever, it’s imperative to make sure your CPT® coding is correct and compliant. Master more coding topics, and break down the complexity with our expert-infused GI/Biliary Interventional Radiology Coding webcast. This webcast is an essential training tool for both audio and visual learners.