Wiki Coding for Colonoscopy bleeds

[karotwo]

I was told , many moons ago, that if you caused the bleed , you fix the bleed and you don't get to charge to fix that bleed.
I have a provider who is sure I am wrong. Finally go this set straight . However, I have a question and I not sure how I am missing this.
Pt has colonoscopy, provider find single medium sized localized angiodysplastic lesion with stigmata of recent bleeding was found in cecum. For hemostasis, one hemostatic slip was successfully placed. No bleeding at end of procedure.
Provider is wanting to charge to control a bleed with 45382 .
To me this is not an active bleed but he states ( to me) a therapeutic intervention such as cautery and endo clips to achieve hemostasis and prevent recurrent bleeding. He says he can charge.
I need all answers here-- these providers are brutal

Thanks

 

[thomas7331]

I'd agree that if the provider caused the bleed in the course of the operative process, then they should not charge for it. However, in the scenario you cite here, the provider did not cause the bleed, but indicated that there was evidence of bleeding, which was then treated. In that case, the provider is performing a medically necessary service to prevent bleeding and it's appropriate to charge for it, so I agree with the provider in this situation. I'm not aware of guidance that states it can only be coded or reported when the site is actively bleeding.

There's a CPT assistant article from September 1996 that addresses this and states that the endoscopic codes for control of bleeding 'are intended to be used when treatment is required to control bleeding that occurs spontaneously, or as a result of traumatic injury (noniatrogenic), and not as the result of another operative intervention.'

It does not state here that the bleeding must be actively occurring at the time of the procedure, only that the treatment is required to control it. It's up to the provider to say whether or not the treatment is required, so if they're doing it then I would code it.

 

[karotwo]

I'd agree that if the provider caused the bleed in the course of the operative process, then they should not charge for it. However, in the scenario you cite here, the provider did not cause the bleed, but indicated that there was evidence of bleeding, which was then treated. In that case, the provider is performing a medically necessary service to prevent bleeding and it's appropriate to charge for it, so I agree with the provider in this situation. I'm not aware of guidance that states it can only be coded or reported when the site is actively bleeding.

There's a CPT assistant article from September 1996 that addresses this and states that the endoscopic codes for control of bleeding 'are intended to be used when treatment is required to control bleeding that occurs spontaneously, or as a result of traumatic injury (noniatrogenic), and not as the result of another operative intervention.'

It does not state here that the bleeding must be actively occurring at the time of the procedure, only that the treatment is required to control it. It's up to the provider to say whether or not the treatment is required, so if they're doing it then I would code it.

Thank you so much. I have read that but was questioning myself --