Need help coding this Colo!!

CBaez

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I received a surgery card and is noted in the report the following:



Colo with EMR (snare polypecty with saline injection assist)

With APC cognulation/ablation of polyp and resolution clip placement



Report:



Indication: Flat large tubular adenoma here for removal, history of partial coletomy/colon cancer



Procedure: The endoscope was passed w/out difficulty through the anus under direct visualization and advanced to the colonic anastomotic region. The scope was withdrawn and the mucosa was carefully examined. The quality of the prep was good and the views were good. The patient's toleration of the procedure was good. Retroflextion was performed in the rectum.



Findings: Anastomosis encountered in the proximal colon at what appeared to the hepatic reflection behind it. Did EMR (endoscoppic mucosal resection with saline lift assist and snare polypectomy). 7cc injected. The polyp was removed by polypectomy. Unfortunately we were unable to remove it in one piece as the snare would not capture the whole thing easily, even though the polyp did appear to lift off the colon wall. We removed the polyp with cold snare polypectomy in two pieces. We used APC coagulation /ablation (15W. 0.6L/min) to ablate any remaining tissue along the edges of the polpectomy site. We placed a resolution clip to approximate the edges of the polypectomy site to help prevent against post-polypectomy bleeding. We attempted to place a second clip but were unsuccessful as it was unable to gain purchase along one side of the clip. There was evidence of mild diverticulosis in the transverse colon and sigmoid colon. Small internal hemorrhoids were found.



Summary:

Anastomosis encountered in proximal colon at what appeared to be the hepatic flexure.
Flat 1.3cm polyp nestled in the crevice b/t two folds at the hepatic flexure with what appeared to be the hepatic reflection behind it
Did EMR (endoscoppic mucosal resection with saline lift assist and snare polypectomy) 7cc injected. Polypectomy was performed.
Unfortunately we were unable to remove it in one piece as the snare would not capture the whole thing easily, even though the polyp did appear to lift off the colon wall.
We removed the polyp with cold snare polypectomy in two pieces.
We used APC coagulation/ablation (15w,0.6L/min) to ablate any remaining tissue along the edges of the polypectomy site.
We placed a resolution clip to approximate the edges of the polypectomy site to help prevent against post-polypectomy bleeding.
We attempted to place a second clip but were unsuccessful as it was unable to gain purchase along on side of the clip.
Mild diverticulosis found in the transverse and sigmoid colon
Internal hemorrhoids found
Otherwise Normal exam

Thanks for any help you may provide! :confused:
 

pamsbill

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Here's the thing: EMR is substantially more tedious, time-consuming, and risky than your average polypectomy. You should be able to use a "22" modifier and obtain extra reimbursement however the physician would have to document in more detail than what you have posted.

With what you have, I believe you are going to get a 45383 and a 45381.

If you can educate your physician(s) about documenting the additional time and risk associated with EMR procedures and you develop a good cover letter stating your case (e.g. "EMR is a delicate, highly-skilled procedure which, if performed successfully, saves the patient from full-fledged colon sugery thereby saving the insurer from having to pay for such" etc. - lay it on thick) you may very well be successful with obtaining extra reimbursement from insurers for this procedure.
 

pamsbill

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Would you use 45385 for snare technique rather than 45383?
I wouldn't because the 45383 is valued higher than the 45385. Since both techniques were used on the same lesion, I would use the higher-valued code.
 
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