Latest Version of NCCI Tightens Up Several Gastro Codes
Published on Wed Jul 07, 2004
Injections are no longer reportable with some EGD procedures When the gastroenterologist injects saline to raise a polyp before removal, you may have considered reporting two codes in the past. But in the future, you should stick to one code at all times, since the new coding edits officially forbid it. In the latest version of the National Correct Coding Initiative (NCCI) edits, submucosal injections are considered part of many endoscopic procedures. The edits also bundle several codes that represent fine needle aspiration (FNA) and endoscopic ultrasound (EUS) procedures.
Read on for more information on the latest round of NCCI edits, which were the rule as of July 1 and will remain in effect until Sept. 30. FNA, EUS Bundles Are Unbreakable The NCCI edits significantly affect several FNA/EUS codes, says Linda Parks, MA, CPC, CMC, CCP, of GI Diagnostic Endoscopy Center in Marietta, Ga.
All of the following edits have an indicator of "0," meaning they cannot be unbundled for any reason. "Still, I don't see these edits being a major problem [for coders], since you should always code to the highest degree of specificity to begin with," Parks says. EGD With EUS Is a 1-Code Claim From now on, when you report an EUS with an endoscopy, 43237 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus) is bundled into 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination). Example: Let's say the gastroenterologist performs an EGD with an endoscopic ultrasound limited to the esophagus. NCCI now requires you to report only 43237 for this procedure. Beware of Reporting FNA With Endoscopy With the new edits, when you report an FNA with an endoscopy, 43238 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s], esophagus [includes endoscopic ultrasound examination limited to the esophagus]) is bundled into code 43237. Example: The gastroen-terologist is conducting an EGD, during which he performs an EUS and an FNA in the same area. You should report only 43238. More Injection Bundles NCCI has also made the following changes to other FNA/EUS codes: 43238 is bundled into 43259 (... with endoscopic ultrasound examination, including the esophagus, stomach and either the duodenum and/or jejunum as appropriate).
43242 (... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/ biopsy[s] [includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate]) is bundled into 43237.
43242 is bundled into 43238.
43259 is bundled into 43237. You Can Undo Injection Edits -- Sometimes The new edits will also affect reporting endoscopic procedures in which the [...]
