Gastroenterology Coding Alert
Think You Can Handle NCCI's Latest Bundles? Test Yourself
To make sure you know how to incorporate the latest National Correct Coding Initiative edits into your everyday coding, take a shot at coding each of the following scenarios. Compare your coding solutions to those provided below. Check Yourself Answer 1: Code only 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Remember, you can report standard PEG replacement only once per patient encounter.
Scenario 1: A patient presents for placement of a PEG tube. The gastroenterologist places the tube and also removes an old PEG tube.
Scenario 2: A patient presents for an endoscopy. During the procedure, the gastroenterologist collects a portion of a stomach lesion for biopsy.
Scenario 3: A patient presents for placement of a PEG tube. During the procedure, the gastroenterologist notices that the esophagus has a foreign object, which she removes. The doctor then places a PEG tube after removing an old PEG tube.
Scenario 4: A patient presents for a standard endoscopic retrograde cholangiopancreatography (ERCP). Multiple biopsies are taken during the procedure, and fluoroscopy is also used.
Answer 2: Code only 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) for the endoscopy. You should not separately report the biopsy.
Answer 3: For the PEG tube replacement, report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Under these circumstances you should separately report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body) for the object removal. Append modifier -59 (Distinct procedural service) to the latter code to indicate to the carrier that you should be reimbursed for both procedures because the gastroenterologist performed them.
Answer 4: Code only 43261 (ERCP; with biopsy, single or multiple) for the ERCP. NCCI now officially bundles fluoroscopy into all ERCP codes (43260-43272).
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