Gastroenterology Coding Alert

Question: The gastroenterologist performs an upper gastrointestinal endoscopy (EGD) to control bleeding of a gastric ulcer (no perforation mentioned in notes). During the encounter, he also removes a pair of gastric varices. Can I report both EGDs, and if so, how?

Kentucky Subscriber

Answer: Yes you can, but you'll need to order the codes properly. On the claim, report the following:

• 43244 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices) for the ligation

• 747.61 (Other anomalies of peripheral vascular system; gastrointestinal vessel anomaly) appended to 43244 to represent the patient's varices

• 43255 (... with control of bleeding, any method) for the EGD

• 531.4 (Gastric ulcer; chronic or unspecified with hemorrhage) appended to 43255 to represent the patients bleeding ulcer

• modifier 59 (Distinct procedural service) appended to 43255 to show that it was a separate service from the control of bleeding EGD.

Caveat: If you do not append modifier 59 to 43255, you could face a denial for the second EGD -- the insurer might think the band ligation caused the bleeding, and deny part of your claim.Available

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.