# EGD vs push enteroscopy



## Anna Weaver

Okay guys, I have a question. We have a new physician and he does push enteroscopy a lot in place of EGD. I had never heard of this and am starting to research. I have found the differences, but how do you code? He says there is more involved in this than a regular EGD, but the code they have been using has about half the RVU of an EGD. 
44361 (with bx) RVU 4.76 vs 43239 (with bx) (8.99). Now, I know we can't code based on RVU, that's not the issue. My question is, how do you code for the enteroscopy? Does anyone else code for enteroscopies? Help please?


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## j.berkshire

To determine which code to use for endoscopy/enteroscopy, determine the ultimate depth of the scope.  If the physician indicates the scope passed beyond the second portion of the duodenum (D2), code from the family of enteroscopy, the 44360 series.  See the description in CPT.  The facility RVUs are 3.88 for 43235 and 4.22 for 44360.


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## Anna Weaver

*push enteroscopy*

Okay, so I have found he is doing the enteroscopy, the scope goes into the jejunum, why are the RVU's for push enteroscopy half as much as the RVU for EGD? This I don't understand. The way our GI Doc explained things to me is that this requires more work, is more in depth, why then does it pay less? Any thoughts?


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## j.berkshire

Anna Weaver said:


> Okay, so I have found he is doing the enteroscopy, the scope goes into the jejunum, why are the RVU's for push enteroscopy half as much as the RVU for EGD? This I don't understand. The way our GI Doc explained things to me is that this requires more work, is more in depth, why then does it pay less? Any thoughts?



Anna,  Check the RVUs for the facility setting, not the non-facility setting.  This procedure is almost always done in a facility setting.  43235 has 3.88 RVUs and 44360 has 4.22 RVUs in the facility.  But you're right:  there isn't much more value placed on the enteroscopy as compared to the EGD.  It's just another quirk with the RVU factors.


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## Anna Weaver

*push enteroscopy*

Thanks Jenny, I appreciate your input. This is the first Doc I've seen that uses the enteroscopies, all the other's I have coded for use the EGD only. A big switch. But, oh well, that's the joy of this job. There's always something different and as soon as you learn that, something else pops up. LOL. 
Anna


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