Wiki Coding Colonoscopies/EGD's


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I have a situation. I am still new at this coding bare with me. I work for a Gastroenterologist and he wants me to code a Colonoscopy with biopsy ablation of polyps (45383) and Colonoscopy with biopsy (45380-59). I have tried to explain that many of the payers do not like these codes because they say it's excessive. I agree with them because the first code already has the biopsy included, as well as the ablation. Also, he wants to code 43239 with 44360 and the payers have actually upcoded the enteroscopy code from 44360 to 44361 and dropped the EGD code 43239. I need some pointers. Am I wrong for agreeing with the payer or is doc right in coding these together? I am a little stressed because I know I am still new at this. Help...:(


Felicia, CPC-A
colonoscopy CMS guidelines

"if a single lesion is biopsied but not excised, use only the biopsy code."

"If a biopsy of a lesion is obtained and the remaining portion of the same lesion is then excised, code only for the excision"

"If multiple biopsies are obtained(from the same or different lesions) and none of the lesions are excised, use only the biopsy code and list it once."

"if a biopsy and an excision are performed, use both codes when the biopsy is taken from a different lesion than that which is excised, and the code for the excision does not include the phrase "with or without biopsy". if such a phrase is included, do not use a separte biopsy code".

The information was taken from the FASA 2004 Effective Coding for ASCs. Hope this helps!!