EGD versus Enteroscopy

Barbara A. Love

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Could someone please clarify the difference between CPT codes 43235 (EDG) and 44360 (Enteroscopy). If our physician performs an EGD and documents advancing the endoscope to the third or fourth portion of the duodenum and documents an evaluation of all portions along with findings, which code is appropriate? The confusion is due to the wording "an either the duodenum and/or jejumum as appropriate" in 43235 and "enteroscopy beyond second portion of duodunum" in 44360. The codes appear to overlap.

Our physicians explain that their "intent" is to do a EGD. Clinically they are being thorough when they go "beyond the second portion of the duodenum". The coder is coding all EGD's that document "beyond the second portion of the duodenum" as enteroscopies. The physicians state that if they are going to perform a enteroscopy, then they will document that and will only be looking in the small bowel.

Hopefully I am not confusing anyone, I happen to agree with the physicians (I might be wrong) that their intent is to do a EGD and not look at the small bowel so regardless on where they went, it should be coded as a EGD.

Thanks in advance for all the help.

Respectfully,

Barbara A. Love, CPC,CPC-H,CMSCS,CBCS
 

KimmHall

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EGD vs Enteroscopy

Barbara,
I spoke with one of my physicians, for clarification of my own opinion, and he agrees. The intent is to do an EGD and is documented and stated as that. If in fact the intent is for an eneteroscopy the it should be stated as such and the documentation will support the evaluation and concentration of the small bowel.

I hope this helps.
 

codegirl0422

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Stating "beyond the second portion of the duodenum" to me does not warrant 44360-I code this as 43235. I only use 44360 when there is documentation of evaluating the small bowel.

But for "documents advancing the endoscope to the third or fourth portion of the duodenum and documents an evaluation of all portions along with findings, which code is appropriate"-I would use 44360

per coders desk reference:
44360: the physician performs endoscopy of the proximal small bowel and may obtain brushings or washings.The physician places an endoscope through the mouth and advances it into the small intestine.

43235: They physician examines the upper gatrointestinal tract for diagnostic purposes. The physician passes an endoscope through the patient's mouth into the esophagus. The esophagus, stomach, duodenum, and sometimes the jejunum are viewed to determine if bleeding, tumors, erosions, ulcers, or other abnormalities are present.

Hope this helps.
 
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