AGA Industry Coding Assistance
AGA welcomes partnership with industry and other stakeholders to obtain new and update existing medical and diagnosis codes to meet the needs gastroenterologists and their patients.
We can assist in the CPT, ICD-10-CM and HCPCS processes. Please reach out to us early.
Please find below the information AGA needs to assist in the CPT, ICD-10-CM and HCPCS processes. When seeking feedback or sponsorship, you must submit the appropriate, fully completed application form at least eight weeks prior to the published submission deadline for the meeting at which you plan to submit the proposal for consideration by the appropriate body (e.g., AMA CPT Editorial Panel, ICD-10-CM Coordination and Maintenance Committee).
If you are not yet ready to submit an application but would still like feedback on your idea, we can provide guidance as the development matures. Please provide all available information and allow at least eight weeks for feedback.
Required information for:
CPT® code(s)
- Identify if your request is to create a new CPT code(s), revise existing CPT code(s) or delete CPT code(s).
- If you are requesting new a new CPT code(s) or revision to existing CPT code (s), include a brief (five pages or less) executive summary of literature supporting the clinical utility of the device/procedure/diagnostic. Copies and reprints of articles and abstracts should accompany the submission. For less mature technologies, a descriptive narrative explaining the technology and preliminary investigation is adequate.
- A review of safety data regarding the device/procedure.
- A review of outcome/efficacy data regarding the device/procedure/diagnostic.
- A fully completed code change application.
- Data regarding physician work for the procedure (pre-, intra- and post-time) and practice expense for both the facility (outpatient hospital, ambulatory surgical center) and non-facility (office, independent diagnostic testing facility) settings.
- A clinical vignette that describes the typical patient who would receive the procedure(s)/service(s) including diagnosis and relevant conditions should be submitted for the device/procedure.
- Peer-reviewed, published literature (not abstracts) should be identified according to each of the current CPT requirements.
- The listed catalogue price(s) and, if available, a copy of an invoice paid within the past 12 months, for any devices, equipment and supplies involved in performing the procedure.
- The names of three physicians the company feels can comfortably analyze the procedure/device/diagnostic and who have no disclosable interest with the company, and/or no advisory/employee/partner relationship with a venture capital/private equity/hedge fund or a private or public company that may be a competitor or acquirer of the company.
CPT® is a registered trademark of the American Medical Association (AMA).
ICD-10-CM® code(s)
- Identify if your request is to create a new ICD-10-CM code or to revise or delete an existing ICD-10-CM code.
- Clearly define and describe the new diagnosis or condition for which you are requesting a code.
- Provide supporting documentation, such as clinical evidence, epidemiological data, and other relevant information.
- Optional: Provide the background paper as prepared for submission to the ICD-10-CM Coordination and Maintenance Committee.
HCPCS code(s)
- Identify if your request is to create a new HCPCS code(s), revise existing HCPCS code(s) or delete HCPCS code(s).
- Provide a summary of your code request.
- Provide a completed HCPCS application as it will be submitted through the MEARIS™.
Guidance for industry interactions with CPT advisors and staff
Industry and other stakeholders must abide by the AMA Statement on Lobbying regarding contacts with CPT editorial panel member and specialty society advisors.
Industry must not contact AGA society CPT advisors directly to follow-up on the status of a request. All communications must be sent to the society liaison, Leslie Narramore, AGA senior director of regulatory affairs, [email protected], 410-349-7455.
Coding FAQs for screening colonoscopies
We’ve compiled answers to common coding questions many practices have for colorectal cancer screening colonoscopies.
