EGD w/ control of Bleeding

[rcclary]

I have a physician who was performing an EGD and found an actively bleeding ulcer in the duodenum. He inserted a probe to control the bleeding but it was bleeding badly and in multiple sites and was not able to so he did a shot of epinerphine. He tried to do the probe again to control the bleeding but still was not able to and decided to call in surgery for a consult. Should I bill for just an EGD w/ injection (43236) or should I bill the control of bleeding (43255) with a 52 modifier?

[ncgirl]

I guess you bill both as he did perform both even though he couldn't get the result. Any ideas ??

[mhcpc]

CCI bundles 43255 and 43236. I would bill the 43255 (higher RVUs) and use the 52 modifier.

[FTessaBartels]

I would need to see the documentation to be absolutely sure, but my inclincation is to use 43255 without modifier. It sounds to me as if the surgeon actually performed the entire procedure, even if s/he didn't achieve the desired result.

Hope that helps.

F Tessa Bartels, CPC, CEMC

[Lisa Bledsoe]

I agree with Tessa.