AC Financial Services | Reference Guide Authorizations for LLUH GI Physician Consultations: For Services referred to: GI Lab

For procedures requiring a LLUH Physician consult, authorization with ranged visit codes and clinical notes are required: New Patient/Initial Visit Codes: Established Patient/Follow Up Codes: 99201-99205 or 99241-99245 99211-99215 Loma Linda Faculty & Physicians 11370 Anderson Street, Loma Linda, Ca 92354 Tax ID: 330672915

For Nurse visits only please request CPT code 99211

All GI Lab procedures should be authorized as Outpatient Hospital Visits under appropriate Tax ID.

LLUMC Tax ID: 95-3522679: Services rendered by Medical Center’s GI Lab and Surgical Hospital GI Lab only. 11234 Anderson St, Loma Linda CA 92354 POS: 22 Outpatient Hospital

LLUCH Tax ID: 46‐3214504: Services rendered by Children’s Hospital GI Lab only. 11234 Anderson St, Suite A, Loma Linda CA 92354 POS: 22 Outpatient Hospital

All others valid at both facilities - use patient’s age as a guideline. Only the CPT codes for services to be performed should be authorized. All other visits take place with the referring physician, or in the GI Clinic. All pediatric patients MUST have a consult with a LLUH Peds GI Physician prior to any procedure.

Mountain View Surgery Center

All GI Lab procedures at this location should be authorized as Ambulatory Surgical Center under appropriate Tax ID. Services rendered at this facility are screening and EGD procedures.

Please ensure that both servicing provider and servicing facility is covered on the authorization: Servicing provider – LLUH physician with the appropriate Tax ID: 33-0672915 Servicing facility – Mountain View Surgery Center 10408 Industrial Circle Redlands, CA 92374 Facility Tax ID: 33-0539366 NPI: 1821141441

POS: 24 Ambulatory Surgical Center

Highland Springs Medical Plaza – LLU HSSC

All GI Lab procedures at this location should be authorized as Ambulatory Surgical Center under appropriate Tax ID.

81 S Highland Springs Ave #100A, Beaumont, CA. 92223 Facility Tax ID: 42-1745710 POS: 24 Ambulatory Surgical Center

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AC Financial Services | Reference Guide For Services referred to: GI Lab

Procedure: CPT Codes: Description: 43235, 43236, 43239, EGD w/wo Intervention Endoscopic, EGD 43244, 43248, 43249 43235, 43236, 43239, Endoscopic, EGD, Change Gastrostomy Tube Percutaneous W/O EGD w/ Tube Change 43244, 43248, 43249, Guide, Chem Cautery Granulatn Tissue, Replacement Gastro- 43760, 17250, 49452 Jejunostomy Percutaneous, Stomach Surgery Proc Unlisted 45378, 45380, 45381 Colonoscopy w/wo Intervention Colonoscopy 45385 44388, 44389, 44390, 44391, 44401, 44394, Colonoscopy w/wo Intervention 44402, 44403, 44404, Colonoscopy via stoma through stoma 44405, 44406, 44407, 44408 45330, 45331, 45332, 45334, 45335, 45337, w/wo Intervention Sigmoidoscopy 45338, 45346, 45340, 45347, 45349, 45350 Endoscopic, EGD, Ultrasound Guided Fine Needle EUS (Endoscopic Ultrasound) 43259, 43242 Aspiration/Biopsy/ Endoscopic U/S/ Upper 43260, 43261, 43262, ERCP (Endoscopic Retrograde 43264, 43265, 43273, ERCP with or without Flouroscopy, Cholangiopancreatography) 43274, 43275, 43276, XRays: Bile Duct, Pancreas, Bile/Pancreas 43277, 74328, 74330 44380, 44382, 44381, Ileoscopy w/wo Intervention Ileoscopy via Stoma, Diagnostic, XRay Guide 44384, 74360 43235, 43236, 43239, EGD w/ Initial Tube Placement 43244, 43248, 43249, Endoscopic, EGD w/Peg Placement 43246 43235, 43236, 43239, EGD w/ Device Placement Endoscopic, EGD 43244, 43248, 43249 Pouchoscopy w/wo Intervention 44385, 44386 Pouch-oscopy Gerd Tst W/ Mucos Ph Electrod, Gerd Tst W/ Mucos Impede BRAVO Esophageal Acid Reflux Test 91035, 91038 Electrod,>1hr Video 91110 GI Tract Capsule Endoscopy Gastroenterology Procedure, Patency Capsule Placement 91299, 74018 X-Ray Abdomen 1 view 43239, 43235, 43248, EGD with collection of duodenal fluid after administration of IV Secretin stimulation test 43236, 43249, 43244, secretin J2850 Rectal Suction Biopsy 45100 Biopsy Of Change Gastrostomy Tube Percutaneous W/O Guide, Tube Change/Check – Eval by RN 43760, 43761, 17250 Reposition Gastric Feeding Tube Thru Duodenum, Chem Cautery Granulatn Tissue Percutaneous Liver Biopsy 47000 Needle Biopsy, Liver Percutaneous Anal Manometry 91122 Manometry, Anal GI Tract Transit And Pressure Measure, Wireless Capsule, SmartPill 91112 Interp/Report Biofeedback 90911 Anal Biofeedback (1 visit per code) Biopsy of GT site mass 11100 Skin Biopsy

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AC Financial Services | Reference Guide For Services referred to: GI Lab

Procedure: CPT Codes: Description: Sigmoidoscopy, w/Endoscopic Rectal u/s (lower)/ with or without RUS (Rectal Ultrasound) 45341, 45342 Transendoscopic Guided Fine Needle Aspiration or Biospy 91034 (For Peds patient add Gerd Tst W/ Nasal Ph Electrod, 24hr Acid Probe Testing chest x-ray code Single View Chest XRay 71045) 91038

(For Peds patient add Gerd Tst W/ Mucos Impede Electrod,>1hr, Impedance pH probe chest x-ray code Single View Chest XRay 71045) Unlisted code (for Endoscopy via Gastrostomy Tube stoma w/ wo 44799, 17250, 49452, gastrojejnunal tube), Chem Cautery Granulatn Tissue, Gastroduodenoscopy w/wo Intervention 43999 Replacement Gastro-Jejunostomy Percutaneous, Stomach Surgery Proc Unlisted Placement NG/OG Tube By Physician, Change Gastrostomy Tube

43752, 43760, 43761, Percutaneous W/O Guide, Reposition Gastric Feeding Tube Thru Tube Change/Check – Eval by MD 17250, 49452, 43999 Duodenum, Chem Cautery Granulatn Tissue, Replacement Gastro- Jejunostomy Percutaneous, Stomach Surgery Proc Unlisted Change Gastrostomy Tube Percutaneous W/O Guide , Gastro Tube Tube Removal 43760, 44799, 17250 Removal, Chem Cautery Granulatn Tissue Esophageal Manometry 91010 Esophageal Manometry 43197, 43198, 43200, 43201, 43202, 43204, 43205, 43206, 43215, Esophagoscopy 43217, 43211, 43212, Esophagoscopy 43220, 43213, 43214, 43226, 43227, 43229, 43231, 43232 44360, 44361, 44363,

44364, 44366, 44370, Enteroscopy/ Endoscopy 44372, 44373, 44376, 44377, 44378, 44379

Sedation Codes: To be ordered with all procedures except for procedures listed below (see page 4) or if ordered with GA. Use patient’s age as a guideline

99151 - Moderate Sedation; Same Physician; Initial 15 mins; younger than 5 years of age

99153 - Moderate Sedation; Same Physician; each additional 15 mins

99152 – Moderate Sedation; Same Physician; Initial 15 mins; 5 years or older

99153 - Moderate Sedation; Same Physician; each additional 15 mins

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AC Financial Services | Reference Guide For Services referred to: GI Lab

General Anesthesia Codes (Request as Ordered by physician):

00731 – Anesthesia Upper GI Endoscopy (EGD, EUS, Enteroscopy, Secretin Stimulation Test)

00732 – Anesthesia Upper GI Endoscopy (ERCP)

00811 – Anesthesia Lower GI Endoscopy (Colonoscopy, Ileoscopy)

00812 – Anesthesia Lower GI Endoscopy (screening colonoscopy)

00813 – Anesthesia for combined upper and lower GI Endoscopic procedures.

The procedures listed below do not require sedation or GA in the GI Lab (unless otherwise stated on the physician’s order):

 Anal Manometry  Esophageal Manometry  24hr Acid Probe Testing  Impedance PH Probe  Biofeedback  Sigmoidoscopy  Rectal Ultrasound (RUS)

Note to External Providers:

1. The following procedures will require the referring physician to submit clinic notes and/or call the attending physician to discuss the case.

Phone: 909-558-4668 Fax: 909- 558-4187

- ERCP - EGD with BRAVO - Endoscopic US - PEG/G or J Tube Replacement with or without EGD

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