Medicare Coding Look-Up

Have a question on a particular Medicare physician fee schedule (PFS) code and reimbursement in your practice area? CMS provides a tool for physicians and practice managers to help answer coding and other reimbursement information in the Medicare PFS.

To access the CMS Physician Fee Schedule Search Tool, visit: www.cms.gov/apps/physician-fee-schedule.

GI Coding Updates

CPT® 2017 Update
ACG, AGA, and ASGE Release 2017 CPT Coding Manual Update

ACG and the GI societies work closely together to ensure that our members are aware of, and prepared for, coding and reimbursement changes occurring each year. For 2017, there were several changes to Current Procedural Terminology® (CPT) codes for gastroenterology services, including important changes for moderate sedation in Medicare. The 2017 update also features 10 popular Q&As on coding.

To review the 2017 CPT Coding Manual Update developed jointly by the three GI societies, click here.

GI Moderate Sedation

CG Guidance on GI Moderate Sedation and GI Anesthesia Changes — What Do You Need to Know?

GI Moderate Sedation

In 2017, CMS announced changes regarding moderate sedation for certain GI procedures. These changes remain the same for 2018. If you administer moderate sedation while performing certain GI endoscopic procedures, Medicare requires ACG members to report 2 codes on Medicare claims for endoscopic procedures — the code for the endoscopic procedure and a GI-specific moderate sedation code (G0500). If you use an anesthesia professional, you can simply report the procedural code as you have previously done.

Check out ACG’s Moderate Sedation Summary and Educational Tool. ACG has created a summary of these changes and a chart of impacted codes.

GI Anesthesia Changes

Beginning 2018, the following GI anesthesia codes will be deleted: CPT codes 00740 (Anesthesia for upper GI procedures) and 00810 (Anesthesia for lower GI procedures). The CY 2017 base unit for both upper and lower GI services was 5 base units. These codes will be replaced with 5 new codes:

  • 00731 (Anesthesia for upper GI, not otherwise specified) = 5 base units
  • 00732 (Anesthesia for upper GI, ERCP) = 6 base units
  • 00811 (Anesthesia for lower GI, not otherwise specified) = 4 base units
  • 00812 (Anesthesia for screening colonoscopy) = 3 base units
  • 00813 (Anesthesia for upper and lower GI during the same session) = 5 base units

Each base unit is approximately $22.

ICD-10 Playbook

Beginning October 1, 2015, the Medicare claims processing system started using the new ICD-10 codes. In order to help ease with this transition process, ACG has developed a playbook for its members to ensure that they are both appropriately prepared and reimbursed.

  1. Utilize the ACG & The Coding Institute’s “ICD-9 to ICD-10 Bridge” to quickly compare any ICD-9 code to its corresponding ICD-10 code(s).