Gastroenterology Coding Alert
Take a Shot at Injection Reimbursement
Question: While one of our gastroenterologists was performing a colonoscopy on an established patient, he found a hemorrhaging polyp. Because of the bleeding, he injected the polyp with epinephrine before removing it with the snare technique. Can I get reimbursed for the injection?
Vermont Subscriber
Answer: Receiving payment for the injection is possible. You can report an injection code with the polypectomy code in all cases, because most carriers do not consider an injection a component of a polypectomy.
For the colonoscopy with polyp removal, report 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). Report the injection as 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance).
Note: While you can get reimbursed for the injection and the polypectomy, you cannot get reimbursed for both the polypectomy (45385) and for "control of bleeding" (45382, Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]). Even though the polyp was bleeding preprocedure, these codes are bundled when the lesion is at the same site.
Gastroenterology Coding Alert
- Know Risk Indicators for Screening Colonoscopy Patients
If you don't know the risk category for patients who receive screening colonoscopies, your bottom [...] - Use ABNs if You Think Medicare Might Not Pay
Notices are required before billing a patient the remainder of a Medicare bill
CPT 2004 may [...] - ABNs:
What to Change, What to Leave Alone
Medicare is specific on allowable alterations to its ABN form
When it comes to manipulating its [...] - You Be the Coder - Reporting Removal of Multiple Stones
Question: Our gastroenterologist performed an endoscopic retrograde cholangiopancreatography (ERCP) on a patient, extracting three stones [...] - Reader Question:
Take a Shot at Injection Reimbursement
Question: While one of our gastroenterologists was performing a colonoscopy on an established patient, he [...] - Reader Question:
Focus PA Efforts and Max Out Payment Potential
Question: In a gastroenterology office, what kinds of services can a physician assistant provide that [...] - Reader Question:
Observe 3-Year Rule for Patient Status
Question: Our practice recently hired another gastroenterologist to help our overworked physician staff. She performed [...] - Reader Question:
File 1 Code for EGD With Stent
Question: What code should I use for an upper gastrointestinal endoscopy (EGD) with a mesh [...] - Reader Question:
Note Sequence When Coding for Reflux Exams
Question: A primary-care physician referred a patient with severe heartburn to one of our gastroenterologists. [...] - Restructure Appeals With These 6 Steps
Get organized for easier, more productive appeals When your practice receives a denial on a [...] - Read EOBs Before Responding to Denials
What 'noncovered service' really means to your office You can't streamline your appeals process unless [...] - You Be the Expert:
What Makes a Clean Claim?
Question: We are having problems in our family practice with the number of claims we [...] - Reader Question:
Bridge the Communication Gap ASAP
Question: The physicians and billers in my office don't practice open communication, and it's leading [...]
