sleeve gastrectomy w/ intraoperative EGD

JENCOTTLE

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My surgeon wants me to bill separately for the EGD that he is doing during his lap sleeves. He is doing the EGD to "check his work." I don't feel it is appropriate to bill for checking your work but can't find anything in writing to back myself up. Can anyone help me out?
 

jrajala

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Same question

I have the exact same question that I posted out the AAPC world this morning. I absolutely agree with you that it should just be part of the sleeve procedure but would love to see something in writting that I could give back to the provider. If you hear anything will you share with me? Thank you
 

Lujanwj

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This question is asked quite frequently and I think we feel pressure to code for these procedures from the physician.

You're not going to find exact verbiage that says "you can not bill for checking your work". However, NCCI guidelines states that a "scout" endoscopy is not separately reportable which is truly what you dr is doing, he scouting out his own work. The only way to bill for the scope would be if you can justify modifier -58 which would indicate the scope was used for a DX or if you can justify modifier -59 as separate and distinct. Doesn't sound like either scenario works for your situation because Dr already has a DX and it's not a separate and distinct organ.

I've attached the NCCI General Coding Guideline for your reading pleasure. ;o )
 

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