Wiki Double Balloon Enteroscopy

[gina_marie]

Can anyone tell me what codes you use for this procedure? We had been billing the enteroscopy codes, 44378 with a 22 modifier, per the suggestion of another Gastroenterology office in the area, but it doesn't look like Medicare is paying anything over the fee schedule price (it actually looks like they are paying below what they have listed as the reimbursement). I am sending the medical records.

I am wondering what other people are using for these codes and what does the reimbursement look like (I know it will differ around the country and it depends on what you have negotiated with the company) - if you are using the 22 modifier, is it bringing in additional reimbursement?

This procedure is starting to frustrate me - I have spent so much time researching this, trying to find out how to bill it and always getting a dead end!

Any help is appreciated!
Gina

 

[Kisalyn]

Hi Gina,

One of my docs started doing double balloon enteroscopies about a year ago. He only does a couple a month. I also code the 44376-44378 with a modifier 22 for antegrade procedures and the colonoscopy codes with a modifier 22 for retrograde procedures. The equipment reps wanted him to bill out with the unlisted code for the retrograde procedure and against my judgement we tried one on a Medicare patient. That was a mess since Medicare reimbursed us less than what they would have for a normal colon. I appealed that to no end.

Reimbursement is hit and miss unfortunately. Some commercials will reimburse about 10-15% higher than our fee schedule. I don't send records in unless they request them since everything goes electronically and rarely do they request them.

Medicare will request records and they usually pay 15% higher.

What I make sure is that the doctor dictates how much time he spent and have him compare it to a typical enteroscopy (which per him, DBE's last 60-75 minutes compared to a normal enterosocpy lasting 30 minutes). I attach that note to the claim.

-Linh

 

[j.berkshire]

Coincidentally, the March, 2011 issue of "CPT Assistant" answers this question on page 10 with instruction to bill the DBE with 44360 or 44376 for the antegrade portion and 44799 (unlisted procedure, intestine) for the retrograde evaluation.