Transfer to OR/Procedure more Extensive

Katy, TX
Best answers
Patient was admitted to hospital for dysphagia. Dr performed EGD at hospital in the outpatient endo center. Patient has eroded lap band. Dr tried to remove lap band through the egd, but was unsuccessful. Patient was intubated in endo and transferred to the OR. Once in the Or the dr performed a lap band removal, stent placement and J tube. My question is, can I bill for the first egd that was done? Although the band could not be removed, dr was able to go past the second portion of the duodenum. Any suggestions or advice would be appreciated.


True Blue
Best answers
I don't believe so. Typically scope converted to open procedure is coded as the open procedure. Then again if they didn't know what was causing the Dysphagia and the scope was the decision for surgery, I believe you can report it separately but I'm not completely sure.

This is what I found in the NCCI manual so yiu can see my confusion and probably yours as well

6. A “scout” endoscopy to assess anatomic landmarks or assess extent of disease preceding another surgical procedure at the same patient encounter is not separately reportable. However, an endoscopic procedure for diagnostic purposes to decide whether a more extensive open procedure needs to be performed is separately reportable. In the latter situation, modifier 58 may be utilized to indicate that the diagnostic endoscopy and more extensive open procedure were staged procedures.

13. If an endoscopic procedure fails and is converted into an open procedure at the same patient encounter, only the open procedure is reportable. Neither a surgical endoscopy nor diagnostic endoscopy procedure code should be reported with the open procedure code when an endoscopic procedure is converted to an open procedure.
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