Gastroenterology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: What diagnosis do you use for an EGD (43235) performed on a patient to re-evaluate a previous gastric ulcer? The preoperative diagnosis in the patients medical record read history of gastric ulcer, and the ulcer is now healed. Would I use diagnosis code 531.90 (gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation), or ICD9 V12.71 (personal history of peptic ulcer disease)?

  Answer: The diagnosis code you use to report the EGD will be the specific reason why your gastroenterologist felt it was necessary to perform the endoscopy. From your question, the reason is unclear.

While this appears to be a follow-up EGD, it isnt clear whether the gastroenterologist knew the ulcer was healed before he or she performed the endoscopy. If the endoscopy was performed to determine whether the ulcer was healed, you should use 531.90. If the gastroenterologist knew the old ulcer was healed before the EGD was performed, you would use V12.71. Many payers will not reimburse for the procedure if the V code is the only diagnosis code reported.

When the V code is used, coders should check if the patient was presenting with other signs or symptoms such as epigastric pain (789.03). If that is the case, those signs or symptoms should be reported as the primary diagnosis. The V code would then be reported as a secondary diagnosis.