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EGD v small intestine endo coding

  1. Default EGD v small intestine endo coding
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    Our doctor scoped to the jejunum and took bx of gastric erosions, cauterized gastric varices and cauterized jejunal varices. Would you code only 44366 and 44361-59 even though the bx was gastric? Or would you code 44366 with 43239-59? I don't think I've ever been able to definitively determine correct coding scenario in these cases; it is confusing since sm bowel endos pay less than EGD's. Thanks for your input.

  2. #2
    I'll be interested in any discussion we can generate about this topic because I have had so many debates on this subject. Here are my thoughts:

    CCI requires that we code the most comprehensive code and an example I use is the sigmoidoscopy / colonoscopy services and apply the same theory to EGD / enteroscopy services. The enteroscopy is more extensive than the EGD as the colonoscopy is more extensive than sigmoidoscopy. So, if a scope reaches the TI and a biopsy (or any intervention) is taken from the sigmoid colon, the colonoscopy with biopsy code is used. Therefore, if an enteroscopy is done, and a biopsy is taken from the esophagus or stomach, the enteroscopy with biopsy code is used.

    Applying this theory to your coding scenario, I would code 44366-59, 44361.

    Many physicians dispute this coding concept and are reluctant to code following this concept stating their intent was to do EGD or that enteroscopy requires a different scope.

    I posed this question to the AMA through their "CPT Assistant," but they have not responded.

    Any other thoughts?
    Jenny Berkshire, CPC, CEMC, CGIC

  3. Default
    I would be interested in hearing what CPT Assistant has to say. Thanks!

  4. #4
    I agree with Jenny in that codes 44366, 44361 should be used. The scope reached beyond the second portion of the duodenum. A biopsy does not need to occur at the end point of the scope. A biopsy is recorded, coded, and billed if done anywhere along the way, including the stomach.

    A small intestine enteroscopy was done, along with a biopsy, along with control of bleeding. Neither code 44361 or 44366 states where the biopsy/control is to be done.

    V. Davis, CPC
    GI, General Surgery

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