Proper Use of Control of Bleeding Codes May Yield Higher Reimbursements
Published on Wed Dec 01, 1999
Medicare often includes control of bleeding in its reimbursement for endoscopic polypectomies, assuming that the bleeding has been caused by the removal of the polyp, tumor or lesion. But under certain circumstances, gastroenterologists can bill separately for the procedure.
The amount of bleeding involved in most polypectomies usually is not significant and often is controlled by the electrical current used to excise the polyp, according to Kathy Anderson, RN, director of nursing and plant manager of the Indianapolis Endoscopy Center, an ambulatory surgical center serving four gastroenterologists.
On the other hand, there are many situations when the gastroenterologist will perform an endoscopy where the primary purpose ends up being to control bleeding. A heater probe, bi-cap probe or a laser is used to cauterize the bleeding tissue. Some gastroenterologists may prefer to use an injection of epinephrine to control any hemorrhaging.
These control of bleeding techniques frequently are used on arteriovenous malformations (AVMs) and cases of diverticulosis. A patient also may have bleeding tumors or polyps that are too large to be removed endoscopically and must be cauterized to temporarily stop the bleeding until they can be removed surgically. Another situation requiring cauterization is post-polypectomy bleeding, which can occur as much as two weeks after the original procedure, requiring the gastroenterologist to re-insert the endoscope.
In these cases, gastroenterologists should bill for an endoscopic control of bleeding and use a code such as 43255 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method) or 45382 (colonoscopy, flexible, proximal to spenic flexure; with control of bleeding, any method), advises Anderson.
Codes for Control of Bleeding
43227Esophagoscopy, rigid or flexible; with control of
bleeding, any method
43255Upper gastrointestinal endoscopy with control of
bleeding, any method
44366Small intestinal endoscopy not including ileum with control of bleeding, any method
44378Small intestinal endoscopy including ileum with
control of bleeding, any method
45317Proctosigmoidoscopy, rigid; with control of
bleeding, any method
45334Sigmoidoscopy, flexible; with control of bleeding,
any method
45382Colonoscopy with control of bleeding, any method
46614Anoscopy with control of bleeding, any method
Code for Polypectomy or
Control of Bleeding?
The coding dilemma occurs when a gastroenterologist performs both a polypectomy and a control of bleeding procedure at the same time.
If the two procedures are performed in the same area of the gastrointestinal system, Medicare will not reimburse for both procedures, says Anderson. She recommends that gastroenterologists bill for the control of bleeding procedure because it has the higher level of labor intensity.
Peg Hopwood, supervisor of patient accounts for Rockford Gastroenterology, a practice of nine gastroenterologists in Rockford, IL, agrees with Anderson and points out that a polypectomy using hot biopsy forceps in [...]
