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43247 only once??

  1. #1
    Default 43247 only once??
    Clearnace Sale
    He removed the scope and re entered with different equipment. just wanted to check others opinion...
    43247 787.20 935.1

    PROCEDURE PERFORMED: Esophagogastroduodenoscopy with removal of foreign body in the esophagus

    ANESTHESIA: MAC provided by the anesthesiologist.

    INDICATIONS: This is for recurrent dysphagia and weight loss.

    A written informed consent was obtained and the procedure was performed in the endoscopy unit. The patient was placed in the left lateral position and after having been explained the procedure, risks, and benefits IV sedation was given and a bite block was placed.

    A videoendoscope was then introduced from the mouth to the back of the throat and some fluid was suctioned out from the back of her throat. The scope was advanced into the esophagus. A very large amount of debris and old food chunks were noted. I could not go beyond the esophagus at this point. We requested a Roth net to be brought in from other Center, which was subsequently brought down, and there was a halt in the procedure for a few minutes and I had to remove the scope.

    The scope was then reintroduced once the Roth net was available to us. The scope was reintroduced into the esophagus. Debris and large boluses were noted again. A small amount was removed with the help of the Roth net. However, the distal end of the esophagus appeared normal and open. However, in the middle of the esophagus there was still a relatively large amount of old debris of food that was present. It was unclear whether there was a diverticulum there or whether there was a mass effect there. It was felt too risky to be washed without intubating the patient at this point. It was therefore decided to suction out as much as we possibly could and the procedure was terminated. The patient tolerated the procedure well and was transferred to the recovery area in stable condition.

    Dysphagia with solid food in the esophagus, which was partially removed, although the distal gastroesophageal junction appeared open. The possibility of the large diverticulum or a mass could not be excluded.

    We will keep the patient on clear liquids all day today.
    Consider a repeat esophagogastroduodenoscopy tomorrow with the patient on a clear liquid diet and consider a possible endotracheal intubation to protect the airway in case she has more debris of food and in case it needs to be washed down. All these issues will be discussed with the patient and the procedure will be performed at the hospital.

  2. #2
    We've run into this and have "learned our lesson"! The physician did one procedure but did it in two parts, therefore, billing of the single procedure for removal of foreign body is appropriate. If the procedure was difficult and required more time (not including the time to retrieve the right instruments) then documentation of additional time spent/difficulty of procedure would allow you to append your -22 mod. Hope this helps!

    Vicki L Davis, CPC

  3. #3
    This is for a surgery center and 22 is not an option for code 43247. my thought is that 43235 is included in 43247 since it is in the same family of codes. I am just not sure. I know we can't use 22 mod though. Help

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