Gastroenterology Coding Alert

Your lower gastrointestinal endoscopy claims will stand a greater chance of acceptance if you include the appropriate ICD-9 code to prove medical necessity.

Last month, you learned how to zoom in on the right lower endoscopy code in the article "Verify 5 Facts Before Submitting Lower Endoscopy Claims," but your ICD-9 coding is equally important.

Why: "Diagnosis codes can really make a difference in getting a claimed processed correctly," says Lora M. Crawford, CPC, billing manager for Southwest Endoscopy & Surgicenter in Gilbert, Ariz.

Medicare carriers publish their own lists of medical-necessity codes for GI procedures on their Web sites. Insurers consider many symptoms justification for a lower GI endoscopy. Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis., offers this list of often-used ICD-9 codes that insurers commonly accept for lower GI endoscopy claims:

Which code you choose will depend on your gastroenterologist's documentation. Remember: "If a diagnosis does not exist, you cannot just make one up to get the claim paid," Crawford says.

Example: The gastroenterologist performs a proctosigmoidoscopy on a patient with documented persistent diarrhea and bleeding. During the procedure, he has to control bleeding via heater probe.
On the claim, you should report:

• 45317 (Proctosigmoidoscopy, rigid; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) for the proctosigmoidoscopy.

• 787.91 to 45317 to account for the diarrhea.

Note: While the listed ICD-9 codes commonly prove medical necessity on lower GI endoscopy claims, you should check with your individual carrier before using these or any other diagnosis codes on a claim.