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: Depending on your gastroenterologist's documentation, you will use a minimum of two codes to report these services.

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).

Heads up: If the physician documents the supervision and interpretation of the ultrasound, you might be tempted to report 76975  (Gastrointestinal endoscopic ultrasound, supervision and interpretation) with modifier 26 (Professional component) -- but don't do it. The Correct Coding Initiative (CCI) bundles 76975 into all EUS codes. You cannot bill it separately.

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

Remember: 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 she provided the service in a facility setting, such as the hospital.