Gastroenterology Coding Alert

Question: Our gastroenterologist performed an upper gastrointestinal endoscopy with biopsy (43239). Then, according to the patients medical record, an injection therapy of duodenal ulcer was done. The patient underwent injection therapy with epinephrine and hypertonic saline injected around the ulcers in the post-bulbar area. The endoscope was withdrawn. There was no major bleeding. How would I code this?

Colorado Subscriber

Answer: There is not a specific code for injection therapy of a duodenal ulcer, says Pat Stout, CMT, CPC, an independent gastroenterology coding consultant and president of OneSource, a medical billing company in Knoxville, Tenn. You may use an unlisted procedure code or modifier -22 (unusual procedural services) to report the injection therapy, depending on whether or not the injection therapy was done at the same site as the biopsy.

If the injection therapy and the biopsy were at the same site, Stout suggests appending modifier -22 to 43239 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple). If they were in different sites, she would report 43239 and 43499 (unlisted procedure, esophagus). If both procedures were performed at the same site, the service is a little more than an endoscopy with biopsy, and you indicate that additional service with modifier -22, she explains. If the procedures were performed at separate sites, they are separate services and need to be reported as such. Although there is a code to report the biopsy, there is no code to report the injection therapy you have to use the unlisted procedure code.

You will have to supply additional documentation with your claim whether you use modifier -22 or the unlisted code. A copy of the operative report and a separate statement describing the injection therapy should be included with the claim. The separate statement should include the typical time taken to complete the injection therapy and mention a listed service that is its closest equivalent. You will also have to adjust the fee for the biopsy code if modifier -22 is used or suggest a fee for the unlisted procedure code.