Gastroenterology practices need to brace for 2025 CPT code updates and additions. The 2025 CPT code set will have 270 new codes. Along with that, there will be 112 deletions and 38 revisions. Several of these codes will have an impact on Gastroenterology practices and how procedures are coded and charged. These additions and updates will have a particular impact on Gastroenterology practitioners as a lot of these updates pertain to telehealth and remote therapeutic monitoring.
Doctors and clinics across the United States need to navigate the upcoming additions of new CPT codes and modifications of existing ones cautiously in order to avoid billing and coding errors. The purpose of this article is to prepare Gastroenterology practitioners with brief coding and billing guidelines for 2025.
Gastroenterology Medical Coding Guidelines For 2025
There are several interesting updates in terms of CPT codes. These are mostly beneficial to clinics and doctors as a lot of new treatment aspects have been included in the CPT code set.
Update To Code 98975 To Include DTx Intervention
CPT code 98975 isn’t something new. It has been there since at least 2020. When it was first introduced, various news articles exclaimed how medical coding was keeping pace with changing technological progress. Technology, however, progresses rapidly with each passing year. Therefore, there was a need to update code 98975 to include more technology-backed treatment procedures.
What was already covered by 98975? In a nutshell, code 98975 initially entailed remote monitoring of patient health monitoring, data collection, and patient education in terms of devices set up for remote monitoring. This means the code had nothing to do with digital therapeutics (DTx) intervention.
The 2025 update to CPT code 98975 aimed to fill this void. The new update will include digital therapeutic intervention. While there has yet to be a concrete discussion on what can be termed as DTx, we have the definition of the Digital Therapeutics Alliance. According to the alliance, any therapeutic interventions are delivered using software to “prevent, manage and treat” medical disorders.
Gastroenterologists and their patients can benefit immensely from DTx intervention:
- Findings from remote health monitoring systems empower GI doctors to create customized treatment plans for patients. For example, monitoring instances of bloating and diarrhea can enable a GI doctor to find patterns in a patient’s disorder. Based on this finding, the doctor can give more relevant advice and perform behavioral therapies – over digital channels.
- Healthcare personnel can set up symptom-tracking mechanisms for patients suffering from irritable bowel syndrome. Based on the symptoms, a Gastroenterologist can recommend lifestyle advice, changes in dietary plans, and more. Similar approaches can be taken to treat patients with GERD or Inflammatory Bowel Disease (IBD)
You might be wondering, we already have CPT codes for telehealth, then why the a need for separate codes on digital intervention? That’s because telehealth is just a subset of DTx intervention. The latter has a much broader scope.
Telephone-Only CPT Codes Will Be Replaced With Audio-Only CPT Codes
Gastroenterologists need to brace for a new change in the way telephone-only visits are charged. The AMA has decided to replace the “telephone-only” CPT codes – 99441-99443 with “audio-only” codes – 98012-98015. This is done because telephone is no longer the only technological medium for audio-only consultations or visits. Various smartphone apps and online platforms now facilitate audio-only consultation.
CPT Codes 98976–98978 Broadening the Scope of Device Supply
Another important aspect of the 2025 Gastroenterology medical coding and billing guidelines is the update applied to codes 98976–98978. These codes pertain to the supply of devices for remote health monitoring. However, prior to the update, these CPT codes didn’t explicitly take those devices that are used to facilitate the transmission of data for remote therapeutic monitoring into account.
Gastroenterology practitioners can now charge patients for the supply of devices that facilitate data transmission. This will ensure that providers are adequately compensated for the supply of such devices.
Updated CPT Codes to Take Cutting-edge Intra-abdomen Surgical Procedures Into Account
The CPT code set for 2025 will have provisions for novel surgical procedures in the abdomen region. CPT codes 49186 to 49190 have been updated in this regard. Strictly speaking, surgery isn’t a part of Gastroenterology, but these updates are relevant to Gastroenterologists as well.
New CPT Code for Genetic Counseling
Gastrointestinal disorders are often hereditary. Comprehensive genetic testing and counseling for the whole family is of immense benefit to high-risk patients. There is an existing CPT code – 96040 for genetic counseling. However, the problem with that code was the fact that it entailed “face-to-face” counseling with patients. The work of a genetic counselor spans over and above face-to-face interaction. It entails medical decision making, which often involves studying medical reports, analyzing patient history, and more. The new CPT code 96041 replaces the phrase “face-to-face,” ensuring that all the work of medical counselors is recognized, not just face-to-face interaction.
2025 is going to be a year when virtual/online Gastroenterological treatment gets more recognition in the form of new and updated CPT codes. The special focus on digital therapeutic intervention will improve access to quality Gastroenterological care while at the same time ensuring physicians are adequately compensated. It’s a win-win for all. However, remember that the addition of new codes and the latest updates will require some getting used to medical coding. Get in touch with us if you are overwhelmed with these new changes and need some hand-holding.
