Some of the biggest changes for 2020 occurred in the gastrointestinal codes in the radiology section of the CPT® Manual. Many codes were revised to include the specific components of the exam (examples include scout neck X-ray, delayed imaging and oral contrast when performed). Other codes were deleted since the revisions eliminated the need for separate codes.
Per the CPT® Manual the esophagus studies 74220 and 74221 describe a procedure that is a component of an upper GI series and should not be coded separately. Instructional annotations have been added to the GI series codes stating that codes 74220 and 74221 are not to be reported in conjunction with 74240, 74246 and 74248. There are corresponding CCI edits that cannot be bypassed with a modifier.
The upper GI codes have been revised for 2020 and are differentiated by the use of contrast. Additionally, the performance of a small bowel follow-through (SBFT) study is now reported with an add-on code. Code 74240 represents a single contrast study of typically barium. Code 74246 represents air contrast studies. An air contrast study, also called a double contrast study, includes the administration of an effervescent agent, similar to Alka-Seltzer, which releases carbon dioxide into the stomach. This distends the stomach and allows for better visualization.
If SBFT is performed, add-on code 74248 should be reported. SBFT is a series of follow-up images taken to view the passage of the barium through the entire small intestine, all the way to the cecum. This adds 1-2 hours to the time required for the upper GI series.
The small intestine and colon codes have been revised to maintain consistency in the code definitions for this section.
Ensuring the correct code assignment for diagnostic gastrointestinal codes is more straightforward in 2020 as long as the extent of the exam and the use of single or double contrast is properly documented in the radiology report. The current trend of revising codes to ensure clarity and consistency is welcome indeed.
Melody W. Mulaik, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.
