General Surgery Coding Alert

Question: Recently, our surgeon placed a PEG tube during the same session that a gastroenterologist performed an EGD. Should we bill 43246 with modifier 62, or should we report 43750 for our portion and let the gastroenterologist report 43235 separately for his portion?


Virginia Subscriber

Answer: You-re probably more correct to report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) with modifier 62 (Two surgeons).

In this case, each physician performed a distinct component of a single procedure. Therefore, separately reporting 43750 (Percutaneous placement of gastrostomy tube) for the surgeon and 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 GI doctor would probably constitute unbundling, according to most payers.

For a co-surgery claim to work, however, the two physicians must coordinate their billing strategies. This requires three steps:

1. Because co-surgeons each perform a distinct part of the procedure, they can't share the same documentation. Each physician should provide a note detailing what portion of the procedure he performed, how much work was involved, and how long the procedure took.

2. Each physician should identify the other as a co-surgeon.

3. The co-surgeons should link the same diagnosis to the common procedure code.

--Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.