# Clips during colonoscopy?



## Sue B (Jun 23, 2014)

My doctor was told he could bill extra for clips used during colonoscopies. There are no bleeds, using them on large polyps.  I can not find a CPT code for such.  Can you help?:


----------



## cjrottum (Jun 24, 2014)

No these are not separately reportable:

Gastroenterology Coder's Pink Sheet 
Effective Date 10/01/2005 
Publish Date October 2005 
Subject No additional payment for hemoclips or endoclips 
"In gastroenterology, your physician may use a surgical tool, or clip (eg, hemoclip, endoclip or brand name HemoClip), to control a gastrointestinal bleed or to serve as a marker for later surgery. The concern has been whether an additional service can be reported when these devices are used. The answer appears to be no. 

The devices are to be considered like other endoscopic techniques, such as thermal application (laser, heater probe, and bicap) and local injection (hypertonic saline, epinephrine, and ethanol) to control a bleed, and as a marker, like India ink, for surgical resection and later reexamination of the gastrointestinal tract. 

With the hemoclip, the gastroenterologist is often attempting to achieve mechanical hemostasis by the application of the metal hemoclip to a bleeding vessel. In non-hemostatic uses, clips have been used not only as markers, but noted for their use in tissue defects, perforations and anastomotic leakage in the esophagus, stomach and colon, and to aide in the placement of enteral feeding tubes. 

?There is no code for that,? explains Lisa Poppenhouse-Davis, CPC, reimbursement specialist, Internal Medicine Billing Office (14 gastroenterologists, multiple sites), University of Texas Southwestern Medical Center, Dallas. ?You don?t add anything. It is just the type, whatever you are using, as your means to stop the bleeding. We haven?t charged anything extra for it.? 

Code the procedure for the service that is performed. For instance, if you perform an upper GI endoscopy with a hemoclip, report the control of bleed code, 43255 (upper GI, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method). If the clip is being used as a marker, report the service performed, eg, biopsy, eg, 43239, polypectomy, eg, 43250 or 43251, or injection, eg, 43236. The same logic applies if the clips are used for control of bleed or as a marker for an esophagoscopy, endoscopic retrograde cholangiopancreatography (ERCP) or colonoscopy, Poppenhouse-Davis adds. 

http://www.cpmc.org/advanced/endoscopy/physician/endoclip.pdf


----------

