General Surgery Coding Alert

Question: Our surgeon performed an EGD with lesion ablation. The op note also documents that the surgeon needed to use a plasma coagulator to control extensive bleeding that occurred following the ablation. Can we separately bill the ablation and bleeding control?

Kansas Subscriber

Answer: No, you should not bill both 43270 (Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)) and 43255 (… with control of bleeding, any method) for this case. You should claim only the 43270 service.

Here’s why: The National Correct Coding Initiative (NCCI) bundles 43255 as a column 2 code to 43270 based on standards of surgical/medical practice. In other words, if the surgeon must control bleeding as part of an EGD lesion ablation procedure, that work is included in the primary service.

Caveat: If the surgeon documented ablating the lesion and then identifying a different anatomic site that required control of bleeding, you could bill both codes. In that case, you would need to append an appropriate modifier such as 59 (Distinct procedural service) to override the edit pair.