Lower GI Endoscopy ProceduresSince the Centers for Medicare and Medicaid Services (CMS) delayed the implementation of the revaluation of lower GI endoscopy codes in the Medicare Physician Fee Schedule (MPFS) Final Rule for 2015, the agency decided not to recognize the use of new 2015 CPT codes for lower GI endoscopy procedures, and maintain the rates of 2014 for 2015. However, some 2015 CPT codes were introduced for existing procedures that required a new code assignment owing to the changes in code descriptor. CMS created G-codes under HCPCS for those procedures with 2014 code descriptions and crosswalked the reimbursement of those codes to the 2014 rates.

G-codes are defined as the procedure codes developed by CMS for recognizing products, supplies and services that are not included in the CPT codes for which there is a programmatic operating need for identifying them separately on a national level. Physicians should use the G-codes for original (fee-for-service) Medicare and Medicare Advantage plans. Facilities such as hospitals and Ambulatory Service Centers (ASCs) should report 2015 CPT codes irrespective of whether there is Medicare coverage or not. It is important to check with the commercial payer whether they recognize 2015 CPT codes for the new procedures.

Here is a detailed look into using G-codes for coding lower GI endoscopy procedures.

2014 CPT code to the 2015 CMS G-code – Crosswalk

2014 CPT Code 2015 HCPCS Code Long Descriptor
44383 G6018 Ileoscopy, through stoma; with transendoscopic stent placement (includes predilation)
44393 G6019 Colonoscopy through stoma; with ablation of tumor(s), polyp(s) or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
44397 G6020 Colonoscopy through stoma; with transendoscopic stent placement (includes predilation)
44799 G6021 Unlisted procedure, intestine
45339 G6022 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45345 G6023 Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation)
45383 G6024 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
45387 G6025 Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)
0226T G6027 Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); diagnostic, including collection of specimen(s) by brushing or washing when performed
0227T G6028 Anoscopy, high resolution (HRA) (with magnification and chemical agent enhancement); with biopsy(ies)

Reporting 2015 CPT Codes without G-code Crosswalks

New CPT codes that do not have G-code crosswalks to Medicare can be reported with CPT and G-code combination. However, such a code combination can be reported only for Medicare beneficiaries.

CPT 2015 Code Description CMS 2015 Crosswalks For Medicare Plans
44381 Ileoscopy w/dilation 44380, G6021
44403 C-stoma w/endoscopic mucosal resection (EMR) 44380, G6021
44404 C-stoma w/submucosal injection 44380, G6021
44405 C-stoma w/dilation 44380, G6021
44406 C-stoma w/endoscopic ultrasound (EUS) 44380, G6021
44407 C-stoma w/EUS-guided fine needle aspiration (FNA) 44380, G6021
44408 C-stoma w/decompression 44380, G6021
45349 Flexible sigmoid w/endoscopic mucosal resection (EMR) 45330, G6021
45350 Flexible sigmoid w/band ligation (for example, hemorrhoids) 45330, G6021
45390 Colonoscopy w/endoscopic mucosal resection (EMR) 45378, G6021
45393 Colonoscopy w/decompression 45378, G6021
45398 Colonoscopy w/band ligation (for example, hemorrhoids) 45378, G6021

Take note of the following while determining when to report CPT and G-codes for 2015.

  • If the patient is Medicare and the code has not changed from 2014 to 2015, physicians should report the CPT code; and the CMS fees are based on 2014 values.
  • If the patient is Medicare and the code has changed from 2014 to 2015, physicians should report G-code and the CMS fees are based on 2014 values.
  • If the patient is Medicare and the code is new for 2015, physicians should report the 2014 CPT codes since 2015 CPT codes are not recognized by CMS.