Gastroenterology Coding Alert
Use Suitable Modifiers to Separate Two Endoscopic Procedures
Question: Our gastroenterologist recently performed an upper EGD on a patient. During the procedure, he passed the scope into the second part of the duodenum. He found a gastric polyp (211.1) and biopsied it and then performed an endoscopic ultrasound with FNA on a cyst/pseudocyst. I am inclined to bill 43242 with 577.2 then 43239 with 211.1. Can you please advise if this would be the appropriate way to code?
Florida Subscriber
Answer: Since your gastroenterologist performed two procedures, what codes you have proposed to report seems correct.
For the initial biopsy that your clinician performed, you will report it with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple). This is reported with the ICD-9 diagnosis code 211.1 (Benign neoplasm of stomach).
Since your clinician performed the fine needle aspiration biopsy of the second lesion using endoscopic ultrasound, you will have to report this procedure separately. The two procedures are separate and two lesions in different areas were treated making it possible for you to report the two procedures separately.
For the second portion of the procedure, you will report it with 43242 (…with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s] [includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate]).
However, it is important to note that the code 43239 is bundled into the code 43242 as per Correct Coding Initiative (CCI) edits. But, it is possible to unbundle the two codes by using a modifier. So, you will have to append a modifier such as 59 (Distinct procedural service) to 43239. You append the modifier to 43239 as this is the code in column 2 of the CCI edits and is the code with lesser relative value units (RVUs). Because two procedures were performed at the same session your carrier may reduce the payment for the second procedure by 50% depending on their rules for multiple procedures.
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Use Suitable Modifiers to Separate Two Endoscopic Procedures
Question: Our gastroenterologist recently performed an upper EGD on a patient. During the procedure, he passed [...]
