Bridgewater, VA
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We have a new physician here and he does something different that I and the other physicians are not familiar with. Instead of tattooing the patient (45381)for marking purposes he is using an endoclip. It is is not a substance that is injected so I can't use 45381. Is anyone else familiar with this and how do you code this?

I could not find a code for this, I used an unlisted code. I get lucky most of the time and my doctor will use it for control of bleed. But he did use it one other time, similar to what your doctor was doctor and I researched it on every site I could come across. I even went back through some old Gastroenterology Alerts and could not find anything. I found so many examples of when and why they use the endoclip method but in all the articles I read I could never find a code for it.

Endoclips are usually used for a control of bleed.
See if there is an active bleed. I've also seen endoclips
used for tumor marking.
Don't forget to add the technical charge for the endoclips themselves.
It's funny I just read this and this past week my GI Doc used an endoclip for the first time. I have never seen that used before. It was for control of bleeding. Interesting.
"Don't forget to add the technical charge for the endoclips themselves. "
which code to use for Technical Charge??
I have an issue with metal clip.
thank you for your help:)
- ENDOCLIPs are a form of surgical closure/surgical tool - There would not be a specific CPT surgical code for placement of ENDOCLIPs as they could be considered incorporated in the actual closing. There could be a HCPCS Level II supply code for the ENDOCLIPs like anchors or screws that could be reported by the facility if their contract allows the additional reporting for those things. Here is further information regarding this but let me know if I am still not answering your question. In the information it appears to continue to support that just about any code for a given procedure could use ENDOCLIPs or hemoCLIPs if they are controlling bleeding etc so there could be many CPT codes where a surgeon uses these supplies/tools. ICD-9 Coding Clinic, Vol 19 No 4, 4th Qtr 2002 Section 1 "The most common presenting symptom is recurrent, often massive, hematemesis associated with melena (51%). Usually, there are no symptoms of dyspepsia, anorexia or abdominal pain. The lesion is usually identified during ENDOscopy or urgent laparotomy. Occasionally, the diagnosis can be made angiographically. Treatment usually consists of therapeutic ENDOscopy with bipolar electrocoagulation, monopolar electrocoagulation, injection sclerotherapy, heater probe, laser photocoagulation, epinephrine injection, hemoCLIPping or banding." Gastroenterology Coder's Pink Sheet Effective Date 10/01/2005 Publish Date October 2005 Subject No additional payment for hemoCLIPs or ENDOCLIPs "In gastroenterology, your physician may use a surgical tool, or CLIP (eg, hemoCLIP, ENDOCLIP or brand name HemoCLIP), to control a gastrointestinal bleed or to serve as a MARKER for later surgery. The concern has been whether an additional service can be reported when these devices are used. The answer appears to be no. The devices are to be considered like other ENDOscopic techniques, such as thermal application (laser, heater probe, and bicap) and local injection (hypertonic saline, epinephrine, and ethanol) to control a bleed, and as a MARKER, like India ink, for surgical resection and later reexamination of the gastrointestinal tract. With the hemoCLIP, the gastroenterologist is often attempting to achieve mechanical hemostasis by the application of the metal hemoCLIP to a bleeding vessel. In non-hemostatic uses, CLIPs have been used not only as MARKERs, but noted for their use in tissue defects, perforations and anastomotic leakage in the esophagus, stomach and colon, and to aide in the placement of enteral feeding tubes. “There is no code for that,” explains Lisa Poppenhouse-Davis, CPC, reimbursement specialist, Internal Medicine Billing Office (14 gastroenterologists, multiple sites), University of Texas Southwestern Medical Center, Dallas. “You don't add anything. It is just the type, whatever you are using, as your means to stop the bleeding. We haven't charged anything extra for it.” Code the procedure for the service that is performed. For instance, if you perform an upper GI ENDOscopy with a hemoCLIP, report the control of bleed code, 43255 (upper GI, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method). If the CLIP is being used as a MARKER, report the service performed, eg, biopsy, eg, 43239, polypectomy, eg, 43250 or 43251, or injection, eg, 43236. The same logic applies if the CLIPs are used for control of bleed or as a MARKER for an esophagoscopy, ENDOscopic retrograde cholangiopancreatography (ERCP) or colonoscopy, Poppenhouse-Davis adds. Coder Jennifer Vallez, Central California ENDOscopy Center (16 gastroenterologists), Fresno , Calif. , took a different track: she submitted code 44799 (unlisted intestinal procedure) for a procedure that included use of an ENDOCLIP, polyp removal and tattooing. “The patient came in for abnormal CT scan and throat cancer,” she said, adding that she is waiting to see if the payer will pay the claim." http://www.cpmc.org/advanced/ENDOscopy/physician/ENDOCLIP.pdf

information taken from coding coach Med assests