Can You Bill 43255 for Control of Contact Bleeding?
Question: I have a report from a diagnostic transoral esophagogastroduodenoscopy (EGD) procedure. The physician performed the EGD and noted in the report that the patient has localized erosions with active (contact) bleeding in the cardia. Can I report an EGD with control of bleeding or should I report just the diagnostic EGD code for the procedure? Missouri Subscriber Answer: You will assign 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) to report the diagnostic EGD procedure. Since the physician attested that the bleeding was due to contact, that would fall under the complications umbrella. According to the National Correct Coding Initiative (NCCI), when a complication occurs during an operative session, you should not bill for a separate service to treat that complication. The NCCI guidelines emphasize that the treatment of complications should be considered an integral part of the primary procedure and should not be separately coded or billed. Therefore, you cannot use 43255 (… with control of bleeding, any method) to report the physician’s work to stop the bleeding in the cardia. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
