Gastroenterology Coding Alert

Hint:  Details on scope insertion determine GI code family

When you're  reporting lower gastrointestinal endoscopic procedures, scan the note for the scope insertion site and services the physician provided during the endoscopy.

You should make sure you verify four facts before reporting a lower GI endoscopy, says Jill Barron, CPC, coding manager at Gastroenterology Associates of Cleveland:
   the approach method  
   the length of scope insertion
   what the doctor did through the scope
   the patient's diagnosis. 
 
If you address these four areas before you send out your lower GI endoscopy claims, you stand a greater chance at success with payers. First, Determine Approach Method The initial step in coding an GI endoscopy is identifying whether the procedure is an upper or lower GI endoscopy,  says Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis.

Main difference: With upper GI endoscopies, the physician most often inserts the endoscope in the patient orally; in lower GI endoscopies, the approach is via the anus, Rasmussen explained during "GI Endoscopic Coding," a recent teleconference sponsored by The Coding Institute.

Example: If the op note states, "Inserted endoscope anally in Patient X," the procedure would be a lower GI endoscopy. Select Codes Based on How Far the Scope Passed Once you have decided that a procedure is a lower GI endoscopy, you can begin searching the notes for an indication of how far the gastroenterologist inserted the scope into the patient, Rasmussen says.

For lower GI endoscopy claims, you need to know the extent of insertion because there are four separate code sets for lower GI endoscopies. Choosing the right one will depend on how far the gastroenterologist inserted the endoscope. According to Rasmussen, if the gastroenterologist examines:   the anus (up to 5 cm of insertion), choose from the anoscopy code set: 46600, Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 46615, ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.
   the anal canal, rectum and the sigmoid colon (6 cm-25 cm), choose a proctosigmoidoscopy code: 45300, Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 45321, ... with decompression of volvulus.
   the entire rectum, sigmoid colon, and/or performs an exam of a portion of the descending colon up to the splenic flexure (26 cm-60 cm), choose from the sigmoidoscopy code set: 45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 45339, ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.
   the entire [...]