You Be the Coder:
Find the Missing EGD Reimbursement Link
Published on Wed Apr 07, 2010
Question: Our anesthesiologist provided anesthesia during an esophagogastroduodenoscopy (EGD) procedure, at the request of the attending physician. We coded the anesthesia portion with 00810. A note in the documentation mentions the request was due to the patient's symptoms, but no other details were provided. The claim we submitted was denied, but we followed all of the other guidelines provided by the payer, including proof that the anesthesiologist administered Propofol. What did we do wrong? New York Subscriber Answer: One key to the denial might be found in the lack of coding for the patient's condition. Your diagnosis code should indicate the co-existing medical condition that justifies your anesthesiologist's involvement in the case, not the gastrointestinal condition leading to the endoscopy. You may want to consult with your anesthesiologist to verify that the patient had a condition such as: • Parkinson's disease (332.0) • Heart conditions (such as 410.xx, Acute myocardial infarction [...]