Gastroenterology Coding Alert

Question: An EGD was performed on a patient who presented with hematemesis (vomiting blood). After thorough washings, a large vessel was spurting blood below the gastroesophageal junction. A BICAP probe was applied to stop the bleeding, but did not help. Then a Minnesota tube was placed to control bleeding. How should I code this entire procedure? North Carolina Subscriber Answer: The EGD with the BICAP probe to control bleeding should be reported with 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method). The washings are included in 43255 and are not separately reportable.

The Minnesota tube is a type of esophagogastric balloon tamponade in which a balloon is inflated within the esophagus or stomach to apply pressure on bleeding blood vessels and stop the bleeding. Code 43460 (Esophagogastric tamponade, with balloon [Sengstaken type]) should be used to report this procedure. As the CPT definition indicates, balloon tamponades performed with Sengstaken (or Sengstaken-Blakemore) tubes are also reported with this code.

Depending on your payer requirements, you may have to add either modifier -51 (Multiple procedures) or -59 (Distinct procedural service) to 43460 because you are reporting multiple procedures. This month's You Be the Coder and Reader Questions were answered by Linda Parks, MA, CPC, lead coder at Atlanta Gastroenterology Associates.