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Gastroenterology Coding Alert

Improve Your Lower GI Endoscopy Coding With These Stratigies

Published on Sun Aug 07, 2005

Hint:  Details on scope insertion determine GI code family

When you're  reporting lower gastrointestinal endoscopic procedures, scan the note for the scope insertion site and services the physician provided during the endoscopy.

You should make sure you verify four facts before reporting a lower GI endoscopy, says Jill Barron, CPC, coding manager at Gastroenterology Associates of Cleveland:
 

  •  the approach method  
     
  •  the length of scope insertion
     
  •  what the doctor did through the scope
     
  •  the patient's diagnosis. 
     
    If you address these four areas before you send out your lower GI endoscopy claims, you stand a greater chance at success with payers.

    First, Determine Approach Method

    The initial step in coding an GI endoscopy is identifying whether the procedure is an upper or lower GI endoscopy,  says Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis.

    Main difference: With upper GI endoscopies, the physician most often inserts the endoscope in the patient orally; in lower GI endoscopies, the approach is via the anus, Rasmussen explained during "GI Endoscopic Coding," a recent teleconference sponsored by The Coding Institute.

    Example: If the op note states, "Inserted endoscope anally in Patient X," the procedure would be a lower GI endoscopy.

    Select Codes Based on How Far the Scope Passed

    Once you have decided that a procedure is a lower GI endoscopy, you can begin searching the notes for an indication of how far the gastroenterologist inserted the scope into the patient, Rasmussen says.

    For lower GI endoscopy claims, you need to know the extent of insertion because there are four separate code sets for lower GI endoscopies. Choosing the right one will depend on how far the gastroenterologist inserted the endoscope. According to Rasmussen, if the gastroenterologist examines: 

  •  the anus (up to 5 cm of insertion), choose from the anoscopy code set: 46600, Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 46615, ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.
     
  •  the anal canal, rectum and the sigmoid colon (6 cm-25 cm), choose a proctosigmoidoscopy code: 45300, Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 45321, ... with decompression of volvulus.
     
  •  the entire rectum, sigmoid colon, and/or performs an exam of a portion of the descending colon up to the splenic flexure (26 cm-60 cm), choose from the sigmoidoscopy code set: 45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 45339, ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.
     
  •  the entire colon from the rectum to the cecum (more than 60 cm) and/or the last portion of the small intestine or terminal ileum, choose a colonoscopy code: 45378, Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) to 45385, ... with removal of tumor(s), polyp(s) or other lesion(s) by snare technique.

    Example: A patient's encounter form reads: "Scope inserted anally, 23 cm; examined rectum, sigmoid colon." On the claim, you would choose a code from the proctosigmoidoscopy family (45300-45321), depending on whether the gastroenterologist provides therapeutic or diagnostic service during the procedure.

    Use Initial Entries for Diagnostic Service

    After settling on a particular type of endoscopic procedure, coders have to check the encounter form for information that will indicate whether the gastroenterologist gave diagnostic or therapeutic service, Barron says.

    Why? If you report a diagnostic code such as 45300, but your gastroenterologist actually administered a therapeutic service, the claim won't go through.

    Remember this: When reporting diagnostic services, use the first code in the appropriate lower GI endoscopy family. The initial entry in each of the endoscopic families contains the same  wording: "diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)," Rasmussen says. If your gastroenterologist performs a diagnostic lower GI endoscopy, the code you report should contain this phrase.

    For example: Suppose the operative notes on a sigmoidoscopy read: "Used washing technique to collect specimen during Dx." On the claim, you would report 45330 for the sigmoidoscopy.

    Check Indented Codes for Therapeutic Service

    If, however, the gastroenterologist gave therapeutic service during the procedure, you would choose from the codes below the initial entry.

    Therapeutic lower GI endoscopy codes appear below the diagnostic code in each endoscopy family. For example, under the 45378 code for diagnostic colonoscopy, there are several therapeutic colonoscopy codes. To find the proper therapeutic code, check the operative notes for clues about the procedure the physician performed. Then, use those clues to decide on the proper endoscopic code.

    If the op notes on a colonoscopy read, "Used snare to remove two lesions during procedure," you would report 45385 for the colonoscopy.

    Note: For information on acceptable diagnoses for lower GI endoscopies, please see "Put the Right ICD-9 Codes on Your GI Endoscopy Claims" at right.

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