Prepare for 2020 GI CPT® Codes With a Radiology Focus

medical coding for gastroenterology radiologic exams

Many of the CPT® 2020 changes that affect gastroenterology medical coders relate to radiological services. Don’t let these imaging updates slow you down when the codes change Jan. 1, 2020.

Which Hemorrhoidectomy Code Is Moving From Cat. III to Cat. I?

The first series of gastro code changes are for internal hemorrhoidectomy by ligation other than rubber band. In 2020, codes 46945 (single hemorrhoid column/group) and 46946 (2 or more hemorrhoid columns/groups) will add this phrase: “without imaging guidance.”

New CPT® notes for these codes will tell you not to report 46945 and 46946 with ultrasound codes 76872, 76942, and 76998.

New dearterialization code: You also will have a new code that specifically includes ultrasound guidance: 46948 (Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed).

Because the code includes ultrasound guidance, you should not report 46948 with ultrasound codes 76872 and 76942, the CPT® notes state.

The notes with these codes in the CPT® code set offer two more useful instructions:

  • If you report 46948, you should not also report 46945, 46946, or 46221 (rubber band ligation).
  • Code 46948 specifies “2 or more hemorrhoid columns/groups.” If documentation shows transanal hemorrhoidal dearterialization of a single column or group, you should report 46999 (Unlisted procedure, anus).

Bonus tip: The CPT® 2020 code set will delete 0249T (Ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance) and point you to new code 46948 instead.

Update Your Complete Acute Abdomen Series Coding

The next group of CPT® code changes that relate to gastrointestinal medicine are in the radiology code section. Whether your practice performs or orders these services, it’s important for providers and coders to be aware of the updates.

In this section, we’ll focus on complete abdomen series code 74022, which will see revisions to the code descriptor. Compare the 2019 and 2020 descriptors below noting the 2020 requirement for two or more abdomen views:

2019: 74022 (Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest)

2020: 74022 (Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest)

Check Anatomy and Contrast Use for GI Study Codes

You’ll also want to review the radiology section of CPT® for more than a dozen updates to the gastrointestinal (GI) contrast study codes. The studies involved are in the range 74210-74280.

The revisions tend to add wording that the codes include scout and delayed images (when performed) and that these codes represent contrast studies. Knowing these points also will help you choose among the codes:

  • What anatomy was involved? For instance, was it the pharynx, esophagus, upper GI tract, small intestine, or colon?
  • Was it a single-contrast or double-contrast study?

Here’s a quick summary of 74210-74230:

  • Existing code 74210 for radiologic exam of the pharynx, cervical esophagus, or both will see an update to clarify that the code includes any scout neck radiographs and delayed images performed during the test. The new descriptor also specifies it is a “contrast (eg, barium) study.”
  • Esophagus exam code 74220 will be revised to specify that it includes chest scout radiographs and delayed images. The 2020 code set also labels 74220 as a single-contrast study. You’ll use new code 74221 for double-contrast esophageal studies. An example of double contrast is high-density barium and an effervescent agent, the descriptor states.
  • You’ll still have 74230 for a swallowing function study. The revised 2020 descriptor fits the pattern of adding that scout neck radiographs and delayed images are included, and that the service is a contrast study.

In addition to those updates, the upper GI tract study codes from 74240-74280 will see some significant changes.

Upper GI: In 2019, you use 74240 for an upper GI study, and you use 74241 for that same study with KUB. The 2020 CPT® code set deletes 74241 and revises 74240 to look like this: Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study.

The 2020 code set also makes existing code 74246 a child code of 74241 (meaning they share the same descriptor before the semicolon). The descriptor for 74246 also will be revised to use the term double-contrast: … double-contrast (eg, high density barium and effervescent agent) study, including glucagon, when administered. Similar code 74247 (with KUB) will be deleted for 2020.

Upper GI with small intestine: Two more codes that will be deleted for 2020 are upper GI codes 74245 and 74249, both of which include small intestine studies.

Instead there will be a new small intestine study add-on code, which you may use with upper GI study codes 74240 and 74246. The new code is +74248 (Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination)).

Small intestine: We’re not done with changes yet! The 2019 code set includes 74250 (small intestine study), 74251 (same study via enteroclysis tube), and 74260 (duodenography).

The 2020 code set deletes 74260 (pointing you to 74251 instead) and revises the other two codes, using the format you should be familiar with by now:

  • 74250 (Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed single-contrast (eg, barium) study)
  • 74251 ( double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered)

Colon: After all that, the last two changes are fairly simple. Existing codes 74270 (colon contrast enema) and 74280 (colon exam with air contrast and barium) will be revised to match the new pattern:

  • 74270 (Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed single-contrast (eg, barium) study)
  • 74280 (… double-contrast (eg, high density barium and air) study, including glucagon, when administered)

What About You?

Do you think these 2020 GI coding changes are a good match for the services you see?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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