Gastroenterology Coding Alert

Question: We recently saw a new patient who complained of heartburn and difficulty swallowing. Because of the symptoms the patient exhibited, the physician performed a 48-minute E/M service and a diagnostic endoscopy on the same day as the visit and diagnosed the patient with dysphagia and heartburn. How should we code this?

Arkansas Subscriber

Answer: On the claim, you would report 43235 (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)) for the endoscopy; and 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter) for the E/M encounter.

You should append append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99204. Then link R12 (Heartburn) and R13.10 (Dysphagia, unspecified) to 43235 and 99204.