Wiki POEM 43497 vs 43180

doxie1064

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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!
 
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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