We have an unusual circumstance and need some guidance.
A local bariatric surgeon (not our Dr) performs a gastric bypass on the patient. On post-op day 1, the patient had hematemesis and our GI doc (Dr A) performed an EGD and determined the patient had an active bleed. Later the SAME DAY, the bariatric surgeon takes the patient back to the OR. While in the OR, he calls A DIFFERENT one of our GI docs (Dr. B) and asks him to come assist. When Dr. B arrives, the endoscope is already inserted in the patient. Dr. B takes over the scope and looks around the stomach, while the bariatric surgeon places some more sutures laparoscopically. Our GI Dr B then notes in his dictation that once the bariatric surgeon placed the additional sutures, the bleeding had ceased.
Here are my questions:
1. Do we bill for a limited EGD (43235)? With a -52 modifier?
2. Do we need to attach an assistance surgeon modifier? 80 vs 81?
3. What about the fact the our Dr. A performed an EGD earlier that day? EGD’s don’t have a global, but would the bariatric surgery global affect us since we assisted them?
4. If the bariatric surgery has a global and their Dr. can’t bill for the return to the OR, is all this a moot point, and I should just bill out a 43235-52?
I have contacted the bariatric surgeons office to inquire as to if/what they would be billing, but their Dr hasn’t dictated the note yet. I have no idea what CPT codes they would be using.
Thanks for any input!
Bridgette Martin, LPN, CPC, CGIC