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Gastroenterology Coding Alert

Reader Questions:

Separate Interp From EGD to Max Out Pay

Published on Tue Jul 28, 2009

Question: An established patient reports to the gastroenterologist complaining of a burning pain in his abdomen and frequent belching. During a level two E/M service the gastroenterologist begins to suspect an H. pylori infection. The gastroenterologist performs an inoffice endoscopy with biopsy (we own the testing equipment and have a CLIA waiver). She then interprets the test results, which confirm the condition. Is the test interpretation part of the screening? Missouri Subscriber Answer: Payers consider the biopsy interpretation a separate service when the gastroenterologist tests for H. pylori via endoscopy. On the claim, report the following: • 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) for the EGD • 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; [...]
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