Gastroenterology Coding Alert

Question: Our gastroenterologist performed a duodenal intubation as well as a gastric intubation on the same date to collect material for examination. The insurer only paid for the duodenal intubation code (43756) and then denied the gastric intubation code (43754). Can you advise?

Codify Subscriber

Answer: You haven’t indicated why the physician performed both procedures on the same date, but that is typically an uncommon occurrence, since the doctor can usually collect the appropriate material during one or the other, precluding the need to do both.

However, if you do perform both, there is not a way to collect for both services from Medicare or any other payers that follow the Correct Coding Initiative (CCI) edits. Under CCI, 43754 (Gastric intubation and aspiration, diagnostic; single specimen [eg, acid analysis]) is bundled into 43756 (Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen [eg, bile study for crystals or afferent loop culture]).

It won’t help you to break out a modifier such as 59 (Distinct procedural service) to separate the services. CCI states, “Code 43754 is a column 2 code for 43756, These codes cannot be billed together in any circum­stances. CCI edit Rule: Mutually exclusive procedures.” Therefore, you will only collect for the duodenal intubation code 43756.