In addition, new CPT codes were created for reporting new technology, such as endoscopic hemorrhoid
Category III codes 0226T and 0227T were converted
to Category I codes 46601 and 46607. Typically either a
colposcope or operating microscope is used for visualization and cannot be separately reported.
In the Medicare physician fee schedule (MPFS) final
rule, discussed in detail in the article on page 10 of
this issue, CMS rejected the recommended CPT code
changes and the American Medical Association Relative Value Scale Update Committee (RUC) work relative value unit (RVU) recommendations. Instead, CMS
decided to maintain the 2014 code descriptors and the
2014 work RVUs for calendar year (CY) 2015.
Because the code set is changing for CY 2015, including the deletion of some of the CY 2014 codes, CMS
created temporary “G-codes” to allow practitioners
to report services to CMS in CY 2015 using the same
code descriptors they used in CY 2014 (that is, providers must report the 2015 G-code for Medicare patients
in lieu of the deleted 2014 code). All Medicare payment
policies applicable to the CY 2014 CPT codes will apply
to the replacement G-codes. The new and revised CY
2015 CPT codes for lower GI endoscopy that Medicare
will not recognize for payment in CY 2015 are denoted
with an “I” (invalid for Medicare purposes).
For Medicare patients, providers should report the
appropriate G-code instead of a code that has a status
indicator of “I” (see Table 1, page 20).
For patients with private insurance, providers will
need to check with the insurers to determine whether
they will follow Medicare policy or allow providers to
report the new codes. Keep in mind that the new codes do
not have published RVUs. Therefore, documentation will
be required to support the payment amount for a claim.
The Colonoscopy Decision Tree (see figure, page 21)
is designed to assist with correct CPT code and modifier selection. There is one correction (highlighted in red)
from the CPT 2015 Professional Edition; when a therapeutic procedure to the cecum is performed, report
Use modifier 52 (reduced
services) for an incomplete
exam for a therapeutic
procedure when the cecum is
not reached. For a diagnostic or
screening exam when it is not
possible to reach the cecum,
use modifier 53 (discontinued
procedure), which allows the
procedure to be repeated and
reimbursed on another date.