2015 Polypectomy Coding and Payment Quick Reference - Boston Scientific

2015 Coding & Payment Quick Reference

Select Polypectomy Procedures

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.

Rates referenced in this guide do not reflect Sequestration; automatic reductions in federal spending that will result in a 2% acrossthe-board reduction to ALL Medicare rates as of January 1, 2015.

Medicare Physician, Hospital Outpatient, and ASC Payments

RVUs

2015 Medicare National Average Payment

Physician,2

Facility3

CPT? Code1

Code Description

Work

Hot Biopsy

43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), 2.40 or other lesion(s) by hot biopsy forceps

43250 Esophagogastroduodenoscopy, flexible, transoral; with removal of

3.07

tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

44365 Small intestinal endoscopy, enteroscopy beyond second portion of

3.31

duodenum, not including ileum; with removal of tumor(s), polyp(s), or

other lesion(s) by hot biopsy forceps or bipolar cautery

44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or

3.81

other lesion(s) by hot biopsy forceps

45308 Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or

1.40

other lesion by hot biopsy forceps or bipolar cautery

45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other

1.79

lesion(s) by hot biopsy forceps

45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other

4.69

lesion(s) by hot biopsy forceps

Total Office

Total Facility

In-Office

In-Facility

Hospital Outpatient

ASC

12.04

4.18

$430

$149

$1,914 $1,050

13.13

5.22

$469

$187

$1,064

$584

5.46

5.46

$195

$195

$1,249

$685

12.52

6.28

$448

$225

$790

$433

6.28

2.59

$225

$93

$827

$454

8.46

3.17

$302

$113

$494

$271

13.21

7.76

$472

$277

$790

$433

See important notes on the uses and limitations of this information on page 3.

CPT copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Effective: 1JAN2015 Expires: 31DEC2015 MS-DRG Rates Expire: 30SEP2015 ENDO-47409-AD DEC2014 1

CPT? Code1

Code Description

Snare

43217

Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

43251

Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

44364

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

44394

Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45309

Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique

45338

Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45385

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

Hot Biopsy or Snare

45315

Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique

Other

43229

Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Foreign Body Removal

43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s)

43247

Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)

44363

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body(s)

45307 Proctosigmoidoscopy, rigid; with removal of foreign body

45332 Sigmoidoscopy, flexible; with removal of foreign body(s)

45379 Colonoscopy, flexible; with removal of foreign body(s)

43194 Esophagoscopy, rigid, transoral; with removal of foreign body(s)

Endoscopic Mucosal Resection

43211

Esophagoscopy, flexible, transoral; with endoscopic mucosal resection

43254

Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection

44403 Colonoscopy through stoma; with endoscopic mucosal resection

45349 Sigmoidoscopy, flexible; with endoscopic mucosal resection

45390 Colonoscopy, flexible; with endoscopic mucosal resection

Work

2.90 3.57 3.73

4.42 1.50 2.34 5.30

1.80

3.59

2.54 3.21 3.49 1.70 1.79 4.68 3.51

4.30 4.97

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

RVUs Total Office

12.83 14.42 6.27

14.15 6.32 9.08 14.88

7.10

20.88

11.73 11.71 5.88 6.39 8.32 14.25 5.56

7.27 8.25

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

2015 Medicare National Average Payment

Physician,2

Facility3

Total Facility

In-Office

In-Facility

Hospital Outpatient

ASC

4.94

$459

$177

$1,064

$584

6.02

$516

$215

$1,064

$584

6.27

$224

$224

$1,249

$685

7.35

$506

$263

$790

$433

2.61

$226

$93

$827

$454

4.04

$325

$144

$827

$454

8.78

$532

$314

$790

$433

3.25

$254

$116

$827

$454

6.06

$747

$217

$1,914 $1,050

4.36

$419

$156

$1,064

$584

5.45

$419

$195

$745

$409

5.88

$210

$210

$852

$467

2.97

$228

$106

$1,657

$909

3.18

$297

$114

$827

$454

7.78

$510

$278

$790

$433

5.56

$199

$199

$1,064

$584

7.27

$260

$260

$1,064

8.25

$295

$295

$1,064

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

Facility Only for 2015 Reporting

$790 $827 $790

$584 $584 $433 $454 $433

See important notes on the uses and limitations of this information on page 3.

CPT copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Effective: 1JAN2015 Expires: 31DEC2015 MS-DRG Rates Expire: 30SEP2015 ENDO-47409-AD DEC2014 2

Medicare Hospital Inpatient Payment:

Inpatient payment information not shown because the polypectomy procedure will rarely, if ever, be the primary reason for a hospital admission.

C-Code Information

For all C-Code information, please reference the C-Code Reference Guide: reimbursement

Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider's responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifies for services that are rendered. Boston Scientific recommends that you consults with your payers, reimbursements specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved label.

T he 2015 National Average Medicare physician payment rates have been calculated using a 2015 conversion factor of $35.7547 which reflects changes for January 1, 2015 through March 31, 2015. Rates subject to change.

1 C PT Copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

2 C enter for Medicare and Medicaid Services. CMS Physician Fee Schedule - January 8, 2015 revised release, RVU15A file

3 Source: November 10, 2014 Federal Register CMS-1613-FC.

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?2014 Boston Scientific Corporation or its affiliates. All rights reserved.

Effective: 1JAN2015

Expires: 31DEC2015

MS-DRG Rates Expire: 30SEP2015

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