Gastroenterology Coding Alert

Question: My gastroenterologist documented performing an EGD with EUS for a patient who presented with severe abdominal pain. He also checked the blood flow in the abdomen to see if it was the source of the patient's throbbing. How should I code this?

Florida Subscriber

Answer: You will need a minimum of three codes to properly report these services depending on the physician's documentation.

First code the esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS) with 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination). Next, if the physician documents the supervision and interpretation of the ultrasound, you should also report code 76975 (Gastrointestinal endoscopic ultrasound, supervision and interpretation) with modifier -26 (Professional component).

From the details you have provided, it sounds as if the next code you should identify is a Doppler study for the abdomen and pelvis. Depending on the physician's documentation, choose either code 93975 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study) or code 93976 (... limited study).

Remember that when you report Doppler studies, you need to append modifier -26 (Professional component) to the code if the physician does not own the equipment or if the service was provided in a facility setting, e.g., the hospital.