Gastroenterology Coding Alert

When your gastroenterologist works with another doctor during a procedure, you could be in for major coding challenges. You will need to coordinate your coding with the other physician's coder. If you don't, both doctors could lose money and face audit scrutiny.

Learn about how to correctly code for procedures shared by two physicians with this real-world case study.

Scenario: A gastroenterologist and a general surgeon performed surgery on a patient. Both physicians worked together on the same procedure. The gastroenterologist performed an endoscopy to locate the correct position along the stomach wall for placement of a percutaneous endoscopic gastrostomy (PEG) tube. The general surgeon made an incision at the same position into the wall of the stomach and used a retention disk to put the PEG tube in place and secure it. Both physicians are going to report the same procedure code.

Coding dilemma: Creta Corrigan, CPC, vice president of operations for Gulfcoast Billing and Professional Services in Venice, Fla., who presented this case study, wonders which codes each physician should report and what modifiers the coders should append.

In this case, each physician would bill using the same code: 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Both coders would also append modifier 62 (Two surgeons), says Cheryl H. Ray, CCS, CPMA, CGCS, a certified coder for Atlantic Gastroenterology in Greenville, N.C.

Pointer: You should only report co-surgeons (using modifier 62) if "two doctors are doing the same procedure, using the same procedure code, but each doing a component different from the other," Ray explains.

In order to use modifier 62, however, each surgeon must perform a distinct part of one procedure and must account for that operative work by appending modifier 62 to the code that best represents the service provided.

Beware: The rules about when you can and can't use modifier 62 may vary by state, so be sure to check your state regulations and your individual payers to see if modifier 62 is right for your practice.

You might be tempted to append modifier 80 (Assistant surgeon) but that modifier is not appropriate since the surgeons in this case are not assisting each other. When each physician takes the lead in some aspect of the procedure, you'll use modifier 62. Use modifier 80 instead when one physician directs the entire procedure and the other just assists at the primary physician's direction.

Pointer: Correlating your coding with the second surgeon's coder is beneficial, especially if the doctors are not part of the same practice. This will ensure both parties are coding the same and reduce the chance of a denial.

If the PEG tube placement described above was performed by two gastroenterologists -- one who led the procedure and the other who acted as a second set of hands to get the PEG tube in the right location -- the primary physician would report 43246 without a modifier and theassistant would report 43246-80 to indicate that he was an assistant.

Warning: Some Medicare carriers and private payers may specify that you have to code dual-physician PEG tube placement by indicating one physician as the assistant, especially when two gastroenterologists perform the PEG tube placement. (See the shaded box below for more on modifier 62 versus modifier 80.)