Question POEM 43497 vs 43180

doxie1064

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Kittanning, PA
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I am working on coding a Z-POEM. Does the new CPT code 43497 include Zenker's diverticulectomy? My provider performed a flexible EGD along with the Z-POEM but there is no code for this....unless I can use 43497. Thank you in advance for any help!
 

Mrsrpc

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Mooresville, NC
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The EGD is inherent in the POEM procedure. So, I'd use 43497, as long as the payer's coverage determination allows it as a medically necessary treatment for the ICD10 associated with diverticulosis. Per NCCI 2022 coding manual:


5. If an endoscopy or enteroscopy is performed as a common standard of practice when performing another service, the endoscopy or enteroscopy is not separately reportable. For example, if a small intestinal endoscopy or enteroscopy is performed during the creation or revision of an enterostomy, the small intestinal endoscopy or enteroscopy is not separately reportable.
 
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