Gastroenterology Coding Alert

Question: Our claim for endoscopic mucosal resection got rejected. What could be the possible reasons?

Utah Subscriber

Answer: Endoscopic mucosal resection (EMR) is removal of a lesion during an endoscopy, using a cap or ligation technique, including injection assisted snare removal techniques. This uses the lift technique to produce a space below the lesion, thereby isolating the lesion from the underlying layer. Subsequently, a specialized device removes the tissue. 

In order for your procedure to qualify for an EMR claim, you must document the following three steps clearly:

• Submucosal injection that lifts the lesion
• Clear-cut demarcation of the lesion
• Endoscopic resection of the lesion.

If your physician did not perform all these three steps, do not report an EMR procedure per se. Then, you may report submucosal injection, snare polypectomy with modifier 59 (Distinct procedural service) on the secondary procedures. If you perform a biopsy on the same lesion as EMR, do not report the biopsy separately. Similarly, you may not report separately the ablation of lesion edges, clipping of a defect, or other bleeding treatment of the same lesion in the same procedure.