ED Coding and Reimbursement Alert

Question: A frantic parent brought a child into the ED after the child swallowed a foreign body (FB). The physician removed the FB from the patient's esophagus with an endoscope. What CPT code best represents this FB procedure?


Minnesota Subscriber

 
Answer: You should choose 43247 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with removal of foreign body) for the FB removal. Also, attach ICD-9 code 935.1 (Foreign body in esophagus) to 43247 to represent the FB.

E/M alert: You might want to check your physician's notes on this encounter for evidence of a separate E/M service. The patient was a child who swallowed an FB, so the physician may well have performed a separate E/M to make sure the patient hadn't suffered any further trauma.

If the documentation justifies a separate E/M, be sure to attach 935.1 and modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to show that the FB removal and E/M were separate services.