201
14 Cod
ding & Payme
ent Qu
uick Re
eferenc
ce
Selecct Hemostasis/Clipping
g Procedure
es
Endoscopy
Payyer policies willll vary and shou
uld be verified prior
p
to treatme
ent for limitatio ns on diagnosiis, coding or siite of service re
equirements.
The
e coding option
ns listed within this guide are commonly use
ed codes and a
are not intended
d to be an all-in
nclusive list. W
We recommend
con
nsulting your re
elevant manualls for appropria
ate coding optio
ons.
Rattes referenced
d in these guide
es do not reflec
ct Sequestration
n, automatic re
eductions in fed
deral spending that will result in a 2%
acrross-the-board reduction to AL
LL Medicare ra
ates on January
ry 1, 2014, unle
ess Congress p
passes legislatiion to stop the sequester.
Me
edicare Ph
hysician, Hospital Ou
utpatient, and
a ASC Pa
ayments
Physicianⱡ2
CP
PT® Code1
Code Des
scription
Con
ntrol of bleeding
Esophagoscopy, flexible, transorral; with control of
o bleeding,
43227
any method
3
Faciliity
MD
Payment
In-Office
MD
P
Payment InFacility
Hospital
Outpatient
Payment
ASC Facility
Payment
$403
$183
$1,013
$560
43255
Esophagogastro
oduodenoscopy, flexible, transora
al; with control
6
of bleeding, any method
$441
$221
$1,013
$560
44366
Small intestinal endoscopy,
e
enteroscopy beyond second
portion of duode
enum, not including ileum; with co
ontrol of
bleeding (eg, inje
ection, bipolar ca
autery, unipolar cautery,
c
laser,
6
heater probe, sta
apler, plasma co
oagulator)
$264
$264
$1,233
$681
44378
Small intestinal endoscopy,
e
enteroscopy beyond second
portion of duode
enum, including illeum; with contro
ol of bleeding
(eg, injection, bip
polar cautery, un
nipolar cautery, la
aser, heater
6
probe, stapler, plasma
p
coagulato
or)
$420
$420
$1,233
$681
44391
Colonoscopy thrrough stoma; with
h control of bleed
ding (eg,
injection, bipolarr cautery, unipola
ar cautery, laser, heater probe,
6
stapler, plasma coagulator)
c
$504
$257
$737
$407
45334
Sigmoidoscopy, flexible; with con
ntrol of bleeding (eg, injection,
bipolar cautery, unipolar cautery, laser, heater prrobe, stapler,
6
plasma coagulattor)
$167
$167
$779
$431
45382
Colonoscopy, fle
exible, proximal to
t splenic flexure
e; with control
of bleeding (eg, injection, bipolarr cautery, unipola
ar cautery,
6
obe, stapler, plas
sma coagulator)
laser, heater pro
$611
$336
$737
$407
See im
mportant information about the uses and limiitations of this docume
ent on page 3.
CPT
T Copyright 2013 Ame
erican Medical Association. All rights reserv
ved. CPT is a registere
ed trademark of the A
American Medical Asso
ociation
Effective: 1JAN2014
Expires: 31DEC2014
MS-DRG Rattes Expire: 30SEP2014
END
DO-47409-AC FEB2014
Page 1 of 3
Physician
CP
PT® Code1
Code Des
scription
ⱡ2
3
Faciliity
MD
Payment
In-Office
MD
P
Payment InFacility
Hospital
O
Outpatient
Payment
ASC Facility
Payment
Lig
gation
43205
Esophagoscopy, flexible, transorral; with band liga
ation of
ces
esophageal varic
$155
$155
$1,013
$560
43244
Esophagogastro
oduodenoscopy, flexible, transora
al; with band
ligation of esoph
hageal/gastric varices
$269
$269
$1,013
$560
46221
Hemorrhoidectomy, internal, by rubber
r
band ligattion(s)
$272
$196
$473
$127
43201
Esophagoscopy, flexible, transorral; with directed submucosal
injection(s), any substance
$280
$114
$1,013
$560
43192
Esophagoscopy, rigid, transoral; with directed submucosal
injection(s), any substance
$155
$155
$1,013
$560
43204
Esophagoscopy, flexible, transorral; with injection sclerosis of
ces
esophageal varic
$150
$150
$670
$370
43236
Esophagogastro
oduodenoscopy, flexible, transora
al; with
directed submuc
cosal injection(s), any substance
$396
$153
$670
$370
43243
Esophagogastro
oduodenoscopy, flexible, transora
al; with
injection sclerosis of esophageall/gastric varices
$260
$260
$670
$370
45335
Sigmoidoscopy, flexible; with dire
ected submucosal injection(s),
any substance
$278
$95
$461
$255
45381
Colonoscopy, fle
exible, proximal to
t splenic flexure
e; with
directed submuc
cosal injection(s), any substance
$472
$251
$737
$407
Inje
ection
CLIPPING
End
doscopic Marking
The
ere are no speciffic CPT® Codes for endoscopic tissue marking with a clip; the pro
ocedure defaults to an unlisted prrocedure code fo
or the area in
whiich the clip is being placed (e.g. unlisted
u
procedure code for the in
ntestine: 44799).. Average payme
ents for unlisted procedure codes reflect
payyment for all unlis
sted procedures.. They would not accurately reprresent endoscop ic marking proce
edure payments a
e not listed.
and therefore are
Clo
osure
If a clip is used as a method of closu
ure secondary to
o another procedure then it would
d be considered iinherent in the primary procedure
e. However, if
s
event (e
e.g. the placemen
nt of a clip for clo
osure of a perfora
ation 2 days follo
owing a polypecttomy) it is possib
ble to code
it iss used during a separate
sep
parately for the procedure if clippiing is the only method of closure that is used. Th
he code for this sseparate procedu
ure would be an unlisted
pro
ocedure code for the area in which the clip is place
ed. Average pay
yments for unliste
ed procedure cod
des reflect payment for all unliste
ed procedures.
would not be an accurate
a
representation of closure
e procedure paym
ment and therefo
ore is not listed.
It w
Anc
choring of Jejunal Feeding Tub
be
The
ere is no separatte coding for use of the clip; clip placement
p
would
d be inherent in th
he primary proce
edure coding for attachment of th
he tube. (see
cod
des in the “Entera
al Feeding Codin
ng and Payment Quick Reference
e Guide”)
See im
mportant information about
a
the uses and lim
mitations of this docume
ent on page 3.
Effective: 1JAN2014
Expires: 31DEC2014
MS-DRG Rattes Expire: 30SEP2014
END
DO-47409-AC JAN2014
Page 2 of 3
edicare Ho
ospital Inpa
atient Paym
ment: Ratess Effective Occtober 1, 20133- Septemberr 30, 2014
Me
Medicare Se
everity Diagnosis Related Groups (MS--DRGs) resultting from inpa
atient hemosttasis procedures
may include
e (but are not limited to):
Hospitall
Inpatient
Paymentt4
MSDRG
Des
scription
5
$10,224
377
Hemorrhage with
w Major Comp
plication or Como
orbidity (MCC )
378
Hemorrhage with
w Complication or Comorbidity
y (CC )
$5,816
379
Hemorrhage without
w
CC/MCC
C
$4,023
432
Cirrhosis & alc
coholic hepatitis with MCC
433
Cirrhosis & alc
coholic hepatitis with CC
434
Cirrhosis & alc
coholic hepatitis without CC/MCC
C
5
5
5
$9,946
$5,364
$3,570
C-C
Code Inform
mation: Forr all C-Code infformation, pleaase reference thhe C-Code Refference Guide:
www.bosto
onscientific.co
om/reimbursem
ment
The 2014 National Average
A
Medicare physician
p
payment rates have been calculated
c
using a 2
2014 conversion fa ctor of $35.8228 w
which reflects the 0.5
ⱡT
p
percent update for January
J
1, 2014 thrrough March 31, 20
014.
1
C
CPT Copyright 2013
3 American Medica
al Association. All riights reserved. CPT
T is a registered tra
ademark of the Am
merican Medical Asssociation. Applicab
ble FARS/DFARS
R
Restrictions Apply to
o Government Use
e. Fee schedules, re
elative value units, conversion factorss and/or related com
mponents are not a
assigned by the AM
MA, are not part of
C
CPT, and the AMA is not recommending their use. The AMA
A
does not direc
ctly or indirectly pra
actice medicine or d
dispense medical sservices. The AMA assumes no
liability for data conttained or not contained herein.
2
P
PFS Relative Value File Source: CMS Physician Fee Sch
hedule – Decemberr 27, 2013 revised release, RVU14A ffile. http://cms.gov//Medicare/Medicare
e-Fee-for-ServiceP
Payment/PhysicianF
FeeSched/PFS-Re
elative-Value-Files-Items/RVU14A.htm
ml
3
S
Source: November 27,
2 2013 Federal Register
R
CMS-1601-FC.
4
N
National average (w
wage index greater than one) DRG rattes calculated using
g the national adjussted full update sta
andardized labor, no
on-labor and capita
al amounts
($
$5,799.59). Source
e: August 19, 2013
3 Federal Register.
5
T
The patient’s medical record must support the existence and treatment of th
he complication or ccomorbidity.
6
M
May include but is not
n limited to one off the following hemostasis techniques
s: injection, bipolar ccautery, unipolar ccautery, laser, heate
er probe, stapler, p
plasma coagulator.
© 2014 Boston Scientific Corporation
C
or its affilia
ates. All rights reserve
ed.
Effective: 1JAN2014
xpires: 31DEC2014
MS-DRG Rattes Expire: 30SEP2014
END
DO-47409-AC FEB2014
Page 3 of 3