Gastroenterology Coding Alert
43239 Bundled into 44361
Question: I need clarification on the Correct Coding Initiative. Our physician performed an EGD with biopsy and an enteroscopy with biopsy of the stomach and the proximal jejunum. In the CCI, 44361 is not listed as a component code of 43239. I billed 43239 and 44361-51, but Medicare denied 43239 as a component code. Should I have billed 44361 and 43239-59, since these biopsies were in separate sites? Pennsylvania Subscriber Answer: The key to this problem is a careful analysis of the CCI. You will see that 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) is bundled as a component of the more comprehensive 44361 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple). You cannot bill these codes together under any circumstances.
Gastroenterology Coding Alert
- CCI Edits 9.0:
New CPT Codes Bring Bundling Mayhem
You may think you can find your way through the bundling maze for the new [...] - Use CCI to Master the Multiple-Endoscopy Rule
If you are tired of trying to decide whether to append modifier -59 or -51 [...] - CCI Bundles for New CPT Endoscopy Codes
- 2003 National Physician Fee Schedule:
Gastroenterologists See Cuts across the Board
Look for your reimbursement to drop as much as 12 percent for some endoscopy procedures [...] - You Be the Coder:
Follow Multiple-Endoscopy Rule
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Reader Question:
Use 9925x for Nursing Home Consultations
Question: Our gastroenterologists recently began performing consultations with nursing home patients. I am unclear on [...] - Reader Question:
Report Separate Diagnosis Codes
Question: We are having trouble with claims being denied for hospital follow-up visits on the [...] - Reader Question:
43239 Bundled into 44361
Question: I need clarification on the Correct Coding Initiative. Our physician performed an EGD with [...] - Reader Question:
Use V Code As Secondary Diagnosis
Question: Our gastroenterologist performed a colonoscopy for a rectal bleed. The patient also had a [...] - Reader Question:
CMS Changes Hepatitis B Policy
Question: We have had problems reporting and receiving reimbursement for hepatitis B vaccines lately. I [...]
