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Gastroenterology Coding Alert

Reader Question:

Understand the Meaning of Separate Procedure in the Descriptor

Published on Mon Mar 12, 2012

Question: I am new to gastroenterology coding. Can someone clarify for me what the wording for CPT® code 43235 means? It reads "... with or without collection of specimen(s) by brushing or washing (separate procedure)." My gastroenterologist is asking why he cannot bill for brushing as a "separate procedure" since that is what the descriptor states.Virginia SubscriberAnswer: The descriptor to CPT® code 43235 reads "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 code 43235 is used to report an upper gastrointestinalduodenoscopy (EGD) procedure that is purely diagnostic in nature. A descriptor that includes the phrase [separate procedure] means that this code may not be reported separately with a related procedure from any other codes in that family of services. In this case, it means that code 43235 is included in [...]
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