Coders can use control-of-bleeding codes for situations other than when a gastroenterologist uses a cautery, such as a heater probe, bi-cap probe or laser. The codes are defined by CPT to include any method used to control bleeding, which includes injections of epinephrine and sclerosing agents, as well as band ligation techniques.
Epinephrine injections, for example, can be used instead of cauterization to control bleeding of arteriovenous malformations (AVMs), ulcers or diverticula. The phrase any method in the CPT definition for control of bleeding includes injections as well as cauterization, says Pat Stout, CMT, CPC, an independent
gastroenterology coding consultant in Knoxville, Tenn. If a gastroenterologist injects epinephrine into a bleeding duodenal ulcer, report 43255 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]; with control of bleeding, any method) for the endoscopic injection of the epinephrine.
Report an epinephrine injection to control bleeding in combination with a polypectomy or biopsy, as long as the polyp was in a different location than where the control of bleeding was performed. For example, if a biopsy is taken from a polyp found in the stomach and epinephrine is injected into a bleeding duodenal ulcer, report both procedures.
When to Use Modifier -59
In the above situation, 43239 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]; with biopsy, single or multiple) should be used to report the biopsy. Use 43255 to report the control of bleeding, with modifier -59 (distinct procedural service) attached. Even though 43255 with a 2001 transitioned facility relative value unit (RVU) of 7.23 vs. 4.59 for 43239 is the higher-valued procedure, it is the code that is normally denied by a payer because it is bundled into the biopsy code.
You always add modifier -59 to the code that would otherwise be denied, Stout explains. Its the control-of-bleeding procedure that is usually bundled into the other endoscopic procedures and not the other way around, so that would be the procedure that Medicare and other payers would tend to deny.
Because these codes have the same base endoscopic code (43235, upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), the multiple endoscopy payment rule applies. The control-of-bleeding procedure should be reimbursed at 100 percent of its allowed fee because it is the higher-valued procedure. Payment for the biopsy code will be the difference between it and its base endoscopic [...]
