Gastroenterology Coding Alert
Nix Esophagoscopy/Upper GI Scope Combo
You-ll no longer get separate reimbursement for esophagoscopy 43202-43232 with upper GI endoscopy 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). Version 11.3 of the National Correct Coding Initiative (NCCI) bundles 43202-43232 to 43235 and will not allow separate billing using modifier 59 (Distinct procedural service)--or any other modifier.
Edits reinforce clinical practice: If you-re coding correctly, these latest edits shouldn't affect you.
-This edit extends the prior edit of 43200 [Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)] with 43235 to include all esophagoscopy therapeutic codes,- says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel. -There are now no therapeutic procedures unique to the esophagoscopy codes that cannot be described in an endoscopy code (43235-43255).- The edits therefore reinforce standard billing conventions for upper endoscope procedures, Weinstein says.
Check your calendar: NCCI 11.3 took effect Oct. 1.
Gastroenterology Coding Alert
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Nix Esophagoscopy/Upper GI Scope Combo
Modifiers can't save you from this bundling edit
You-ll no longer get separate reimbursement for esophagoscopy [...] - READER QUESTIONS:
Forget 'Prolonged' pH Monitoring
Question: How should I report a seven-hour pH electrode test for GERD? I can't find [...] - READER QUESTIONS:
Supplies Are Included in GI Procedures
Question: One of our physicians recently asked if we could charge separately for brushes used [...] - READER QUESTIONS:
Report 1 Biopsy Code for Multiple Lesions
Question: How should I report multiple biopsies and/or polypectomies during the same session? For instance, [...] - READER QUESTIONS:
Stent Is Independent of ERCP
Question: Can we report a separate procedure code to describe pancreatic stent placement and removal [...] - READER QUESTIONS:
Category III Code Your Only Choice for ELGP
Question: One of our GI physicians is using ELGP to treat GERD. How should we [...] - READER QUESTIONS:
Choose Either 45378 or G0105
Question: Our gastroenterologist performed a colonoscopy for a rectal bleed on a Medicare patient. The [...]
