Gastroenterology Coding Alert

Question: While performing an upper gastrointestinal endoscopy (EGD), the gastroenterologist took a biopsy and removed a separate lesion using hot biopsy forceps. How many codes should I report for this combination of endoscopic procedures?

Rhode Island Subscriber

Answer: Situations in which patients require more than one upper gastrointestinal scope are very tricky to report, as this question indicates.
 
In this case, you should first report 43250 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) for the removal of the lesion.
 
For the biopsy, report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) with modifier -59 (Distinct procedural service) appended. While Medicare will pay for the biopsy portion of the second procedure, some payers will deny the service even with the modifier.
 
Both codes are payable if the procedures are performed at different sites. The EGD is not reported separately because it is bundled into both 43250 and 43239. Be sure to report 43250 first, because it has a higher relative value unit  than 43239.