formed as a
result of an
abnormal symp-
tom.) Patients
tend to have
higher out-of-
pocket costs
with diagnostic
colonoscopies,
while a screen-
ing one is typi-
cally 100% cov-
ered by the
payer. This is an
important point
to explain to
patients before
the procedure, so they aren't left angry and confused about any bills
in the event a biopsy or polypectomy is performed.
The good news
There are a few bright spots in the 2016 fee schedule for ASCs. Centers
will see Medicare reimbursement increases of 4.3% on average for
upper endoscopy (EGD) procedures. A few notable ones include
esophagoscopy biopsies (43202), which increased roughly 2% or about
$8, and esophagus endoscopy repair, which increased roughly 4% or
around $24.
There were also a few big bumps in the flexible sigmoidoscopy fam-
ily, with code 45342 (sigmoidoscopy using endoscopic ultrasound
Coding & Billing
CB
2 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 6
Top Lower GI Endoscopy Code Cuts
Below is a summary of the rate changes for commonly performed lower
GI endoscopy procedures.
SOURCE: American Gastroenterological Association
CPT Descriptor RVU % Change
45380 Colonoscopy with biopsy -17%
45385 Colonoscopy with snare polypectomy -12%
45378 Colonoscopy -9%
G0105 Colorectal cancer screen, high risk 0%
G0121 Colorectal cancer screen, low risk 0%
45384 Colonoscopy with hot biopsy -11%
45381 Colonoscopy with submucosal injection -13%
45388 Colonoscopy, flexible with ablation -15%
45331 Flexible sigmoidoscopy with biopsy -1%
45330 Flexible sigmoidoscopy -13%
45382 Colonoscopy with control of bleeding -16%
