For physicians, chronic digestive issues are some of the most difficult to diagnose. When a patient complains of stomach pain, irregular bowel movements, or abdominal bloating, there are a wide range of possible culprits. The reason for the patient’s discomfort could be as innocuous as a food intolerance, or it could be as serious as colon cancer. One tool that gastrointestinal specialists can use to examine the state of a patient’s digestive system is a gastric emptying imaging study. A gastric emptying imaging study is a nuclear medicine procedure that can provide insight into the way food is moving through a patient’s digestive system.
The coding procedures for gastric emptying imaging studies are outlined in the Current Procedural Terminology (CPT) medical code set. Before 2016, there was only one CPT code used for all gastric emptying imaging studies. But at the start of 2016, the original code (78264) was revised, and two more were added (78265 and 78266). The distinctions between the three codes are subtle, so it is important for medical coders to be able to distinguish between the circumstances under which each one is used.
The long descriptors for these codes are as follows:
a) 78264: Gastric Emptying Imaging Study (eg. solid, liquid, or both)
b) 78265: Gastric Emptying Imaging Study (eg. solid, liquid, or both); with small bowel transit
c) 78266: Gastric Emptying Imaging Study (eg. solid, liquid, or both); with small bowel and colon transit, multiple days
However, this basic text does not provide all of the information that medical coders need to know when deciding which one is needed for a particular case. The CPT assistant article from the American Medical Association (AMA) provides more comprehensive instructions for each code:
d) CPT code 78264 should be used for imaging of the stomach, where the procedure lasts for 4 hours or less.
e) CPT code 78265 should be used for imaging of the stomach and the small bowel, where the procedure lasts up to 24 to 26 hours.
f) CPT code 78266 should be used for imaging of the small bowel and colon and colon transit, where the procedure lasts for around 24 to 26 hours.
Handling Cases With Multiple Procedures
When coding gastric emptying imaging studies, a good rule of thumb is that the procedure should only be coded once per imaging study. Also, if both solid and gas phase gastric emptying procedures are performed on the same day, the AMA instructs medical coders NOT to report CPT code 78264 twice.
However, there are some cases in which a solid phase study is conducted on one day and is later followed up with a liquid phase on a later date. In that case, CPT code 78264 may be coded separately for each date of service. But be careful! This only applies to rare cases, in which the physician only intended to do one study at the outset. If two studies were originally intended, the physician usually utilizes a dual phase protocol, so the procedure is only coded once.
Keeping track of the subtle nuances of medical coding for procedures like gastric emptying imaging studies can be a major challenge for medical coders at small clinics — especially as old codes are revised and new codes are added each year. To avoid interference with your revenue cycle, you might want to think about outsourcing to the experts at AnnexMed. That way, you can be sure that all of your procedures are coded correctly. Contact us today to find out more about our services!