One of my docs started doing double balloon enteroscopies about a year ago. He only does a couple a month. I also code the 44376-44378 with a modifier 22 for antegrade procedures and the colonoscopy codes with a modifier 22 for retrograde procedures. The equipment reps wanted him to bill out with the unlisted code for the retrograde procedure and against my judgement we tried one on a Medicare patient. That was a mess since Medicare reimbursed us less than what they would have for a normal colon. I appealed that to no end.
Reimbursement is hit and miss unfortunately. Some commercials will reimburse about 10-15% higher than our fee schedule. I don't send records in unless they request them since everything goes electronically and rarely do they request them.
Medicare will request records and they usually pay 15% higher.
What I make sure is that the doctor dictates how much time he spent and have him compare it to a typical enteroscopy (which per him, DBE's last 60-75 minutes compared to a normal enterosocpy lasting 30 minutes). I attach that note to the claim.
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