Gastroenterology Coding Alert

Question: Can you give some insight into coding for chromoendoscopy? Dye is not injected, only sprayed, so we cannot use 45381.

North Dakota Subscriber

Answer: This is one of many services for which there is no specific CPT code. Getting paid for the additional time and effort involved for this still controversial technique has probably limited its acceptance and more wide-spread adoption. You can code the base endoscopic examination with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). Chromendoscopy can be then coded as 43499 (Unlisted procedure, esophagus) appended with modifier 59 (Distinct procedural service) since it is an unspecified code. Most times the insurance carrier will deny the claim but you can appeal with medical documentation. Your physician should write us a letter stating exactly what is involved with the procedure and that might help.