Gastroenterology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: When my physician performs an endoscopy, he consistently enters the third portion of the duodenum; should I report 43235 or 44360? Michigan Subscriber           Answer: If the physician intends to perform an examination of the proximal small intestine as described in the definition of the small bowel enteroscopy CPT Codes , a pediatric colonoscope or a dedicated push enteroscope is required. If your doctor is using a standard upper endoscope, he plans on performing an esophagogastroduodenoscopy (EGD), not a small bowel endoscopy. By entering the third duodenum, he is only conducting a thorough EGD. You should report the intended EGD with 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]). When a clinical indication exists to examine the small intestine that would stand up to an audit for "appropriate and necessary" criteria, use 44360 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). Common indications for small bowel enteroscopy include obscure GI bleeding, abnormal UGI series, and chronic diarrhea.