Wiki CHAP6-CPTcodes40000-49999 Revision Date: 1/1/2022 EGD reported WITH endoscopic Intragastric balloon placement/ removal?

[Mrsrpc]

A physician is placing a intragastric balloon for weight loss. Does he report the EGD with the procedure? New NCCI guidelines say the following, among other things:
"If an endoscopy or enteroscopy is performed as a common standard of practice when performing another service, the endoscopy or enteroscopy is not separately reportable. For example, if a small intestinal endoscopy or enteroscopy is performed during the creation or revision of an enterostomy, the small intestinal endoscopy or enteroscopy is not separately reportable". They also have caveats in that same chapter, but none specific to this type of procedure (it's an unlisted stomach procedure). Any guidance you can give will be appreciated.

 

[thomas7331]

You would not report the EGD. A diagnostic endoscopic procedure is always considered incidental to any therapeutic or more extensive procedure performed through the same approach. This is not a change as of 2022 - this language is carried over from previous versions of the manual.

 

[Mrsrpc]

You would not report the EGD. A diagnostic endoscopic procedure is always considered incidental to any therapeutic or more extensive procedure performed through the same approach. This is not a change as of 2022 - this language is carried over from previous versions of the manual.

Thank you. Is this rule for Medicare only since commercial payers contract differently with different coverage determinations?

 

[thomas7331]

Thank you. Is this rule for Medicare only since commercial payers contract differently with different coverage determinations?

NCCI is part of the Medicare reimbursement policy, but it is followed by many commercial payers as well. Some payers do have their own sets of policies for bundling, but they are usually more restrictive than NCCI, not less.