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Thread: surgical endoscopy includes diagnostic endoscopy

  1. #1
    Join Date
    Apr 2007

    Default surgical endoscopy includes diagnostic endoscopy

    AAPC: Back to School

    1. Per CPT Manual instructions, surgical endoscopy includes diagnostic endoscopy. A diagnostic endoscopy HCPCS/CPT code should not be reported with a surgical endoscopy code.

    2. If multiple endoscopic services are performed, the most comprehensive code describing the service(s) rendered should be reported. If multiple services are performed and not adequately described by a single HCPCS/CPT code, more than one code may be reported. The multiple procedure modifier 51 should be appended to the secondary HCPCS/CPT code. Only medically necessary services may be reported. Incidental examination of other areas should not be reported separately.

    We have a lot of confusion about the 2 listed items above. Would this mean an EGD w biopsy code 43239 should not be billed with EGD peg placement code 43246?

  2. #2
    Join Date
    Apr 2007


    This may better be understand with this illustration: If you do an enteroscopy, you would bill for the enteroscopy beyond D2 (fanily code 44360) as the most extensive service and not bill for the esophagoscopy and EGD. Similarly, if a colonoscopy is performed,you would bill for the colonoscopy as the most extensive service (family code 45378) and not bill for the proctoscopy and sigmoidoscopy. Multiple services within the most extensive service may be billed, according to NCCI guidelines. (e.g. colonoscopy with biopsy in the sigmoid colon and snare polypectomy at the TI billed as 45385, 45380-59)
    Jenny Berkshire, CPC, CEMC, CGIC

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