Gastroenterology Coding Alert

Question: Our gastroenterologist removed four lesions by hot biopsy and three by cold biopsy. There was bleeding when two of the polyps were removed, and sclerotherapy was used to control the bleeding. The biopsies were performed in several areas of the colon. How do I code for multiple biopsies, polypectomies and control of bleeding in the colon?

Kansas Subscriber

Answer: You may bill once for each removal technique, as long as they were performed on different lesions, says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. If the gastroenterologist uses two techniques to remove the same lesion, then you will not be reimbursed for both. The definition for each biopsy or removal code includes the phrase tumor(s), polyp(s), or other lesion(s). Therefore, you can report each removal technique only once, regardless of whether you remove one lesion or 20.

The control of bleeding, which was done with the sclerotherapy, is not separately reportable, Callaway adds. When a gastroenterologist removes or biopsies a lesion, he or she must make sure the bleeding is controlled as part of the procedures standard process.

Some carriers may require you to append modifier -59 (distinct procedural service) to one of the codes to demonstrate that the removal methods were used on different lesions. Because the biopsy and removal codes are not bundled together in the national Correct Coding Initiative (CCI), it is unclear whether this modifier would be required or which code it should be attached to. Coders should contact the payer for a clear directive with this issue. In addition, you might want to ask if the payer will reimburse you for the multiple removal techniques because many payers will only reimburse for one.