Gastroenterology Coding Alert

Question: Recently, our gastroenterologist performed an esopha­gogastroduodenoscopy (EGD) during the same session in which a surgeon placed a PEG tube. How should we report this? Should we bill 43246 with modifier 62, or should we report 43235 for our portion of the procedure and let the surgeon report a different code separately for his portion?

Virginia Subscriber

Answer: You’re definitely more correct to report 43246 (Esopha­gogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube) with modifier 62 (Two surgeons) for this scenario.

In this case, each physician performed a distinct component of a single procedure. Reporting 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) for the GI doctor and a separate code for the surgeon would probably constitute unbundling, based on the similar descriptions of the two services you say were rendered.

For a co-surgery claim to work, however, the two physicians must coordinate their billing strategies. This requires three steps:

1. Because co-surgeons each perform a distinct part of the procedure, they can’t share the same documentation. Each physician should provide a note detailing which portion of the procedure they performed, how much work was involved, and how long the procedure took.
2. Each physician should identify the other as a co-surgeon.
3. The co-surgeons should link the same diagnosis to the same procedure code (43246-62).
4. Medicare contractors hold the first claim until both are received, allow 125 percent of the usual fee schedule and pay each physician 62.5 percent.  Private payers sometimes have different rules.