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 is the difference between billing EGD with biopsy (43239) and an enteroscopy with biopsy (44361)? I've done a lot of reading about these two codes and am having trouble understanding the difference between them. The operative report states smooth duodenal and jejunal folds biopsied for crypt to villous ratio" "" and the preprocedure diagnoses were hoarseness cough and acid dyspepsia.

Maryland Subscriber
  Answer: An EGD (esophagogastroduodenoscopy) and an enteroscopy (also known as ""push enteroscopy"") are two distinctly different procedures although each may examine a portion of the duodenum. The purpose of an EGD is to examine the esophagus and the stomach although the CPT definition of the procedure requires that the endoscope extend into either the duodenum or jejunum. An enteroscopy examines the small bowel and the CPT definition of the procedure calls for the endoscope to be advanced beyond the second portion of the duodenum which is farther than it would go with an EGD.
 
If the gastroenterologist did not clearly specify which procedure was performed you can select the correct CPT code based on the instrument that was used during the procedure. Enteroscopy is performed either with a specific push enteroscope or with a pediatric colonoscope which are usually more than 150 cm long. The standard endoscope used in an EGD is usually 110 cm long.
 
While the medical indications for both procedures can often be the same the symptoms of hoarseness cough and acid dyspepsia that you mentioned are common to gastroesophageal reflux disease (GERD) which is the backward flow of acid from the stomach up into the esophagus and may indicate that the gastroenterologist was examining the esophagus and stomach.
 
If you have any doubts as to the correct code however you should ask the gastroenterologist what procedure the patient was scheduled to receive. He or she should quickly be able to tell you whether it was an EGD or enteroscopy.   "