Wiki EGD question

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amccracken1108

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Our Dr performs 43258 - EGD w/ablation. He performs the procedure once and then removes the scope, cleans it and then performs only the esophagoscopy 43228. These 2 codes are not billable together. The notes clearly state the removal of the scope to clean and re-enter to perform the procedure again, but he is only putting the scope to the esophagus so we cannot bill a 76 modifier on the 43258 because he is not repeating the full procedure. How do we bill this?
 
They are not billable together because the approach (esophagoscopy) is not billable once a procedure has been performed in the same encounter via the same approach.
 
I do understand they are not billable together. Is there anyway we can bill in the future using mod 22 if its documented in the notes that the procedure took longer because of re-entering?
 
Possibly with really great documentation. What is the reason for the re-entry I guess is what is going to need to be the basis for the use of the 22.
 
The Dr. performs the EGD, with the ablation of the esophagus. Removes the scope and cleans it and re-enters to the esphagus and repeats the ablation process to confirm complete ablation of the areas.
 
Good documentation

There is a really good 2 page spread about modifier 22 in the AAPC Coding Edge Magazine for this month (May 2011). It talks about when, how and some basics about the modifer. It may help with knowing what to include in the notes to get reimbursed. Just a suggestion...

If you don't have access to the magazine, I believe this site will put it up or I can work on uploading it and/or send it to you.

Good luck!
 
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