Gastroenterology Coding Alert

Question: Our gastroenterologist performed an EGD. During the procedure, a lot of bleeding occurred from a pinpoint hole in the gastric mucosa; the physician attempted to control the bleeding by injecting 1ml epinephrine (1:10,000) into the area. However, the bleeding continued. So, our gastroenterologist then tried to cauterize the area to arrest the bleeding and was successful. Now our gastroenterologist is of the contention that the procedures should be billed using 43236, 43255 and 43258. Is this correct?

Michigan Subscriber

Answer: From your description, it is very clear that your gastroenterologist mainly attempted to control the bleeding using two different procedures. These different procedures were performed on the same site with the intention of bleeding control only.

So, in this scenario, you will only need to report the EGD code that covers control of bleeding. Therefore, you will only need to report this procedure with 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method).

Going by the code description, you will notice that this code is used when any method is used for the purpose of control of bleeding through endoscopy. So, even though two different methods were used to achieve bleeding control, you will only use 43255 to report the procedure.

Warning: If injection or cautery is used for the purpose of achieving bleeding control, then it is wrong to code either of the procedures with 43236 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection[s], any substance) or 43258 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique) although the descriptors look convincing that you have to report them with these codes. Instead, you will need to stick with 43255 when either procedure is used to help achieve bleeding control.