Gastroenterology Coding Alert
Append Modifier 25 to Differentiate E/M Services
Question: The gastroenterologist also performed a diagnostic proctosigmoidoscopy (45300) to determine if a cause other than hemorrhoids is responsible for the bleeding. The scope revealed no problems in the rectum, sigmoid, or colon. The gastroenterologist then ligated several hemorrhoids using rubber bands (46221). How should I code for these procedures? Illinois Subscriber Answer: You must, however, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service to differentiate it from the inherent E/M component of the other procedures provided on the same date. Therefore, your claim would read: Warning:
Gastroenterology Coding Alert
- CCI 16.1 Update:
Watch Out for New Hemorrhoidectomy, Fluoroscopy Coding Hurdles
The upside is that you'll be able to break some bundles with modifier 59. Just [...] - Check the Modifier Indicator Before Overriding CCI Edits
Key: Make sure your documentation will stand up to scrutiny before appending 59. In certain [...] - Case Study:
Tackle PEG Tube Co-Surgeon Challenges Using Modifier 62
Don't fall into the trap of always using modifier 80. When your gastroenterologist works with [...] - You Be the Coder:
Sometimes You May Need a Separate E/M Code
Question: My gastroenterologist treated a nursing home patient in the emergency department with a displaced [...] - 62 vs. 80
Modifier 62 (Two surgeons): You should look to modifier 62 when your gastroenterologist participates in [...] - Don't Become Ensnared in Polyp-Removal Codes
Choose the right code by pinning down the removal method. If you don't correctly code [...] - Reader Questions:
Consider Base Code Included in 45334
Question: My gastroenterologist performed a diagnostic sigmoidoscopy (45330), followed by sigmoidoscopy with control of bleeding [...] - Reader Questions:
Use 53 for Procedure Halted for Health Reasons
Question: The gastroenterologist performed a diagnostic upper gastrointestinal endoscopy (EGD). While inserting the endoscope, he [...] - Reader Questions:
Use ED Codes With Confidence
Question: A patient with acute gastroenteritis comes to the emergency department (ED). The ED physician [...] - Reader Questions:
Append Modifier 25 to Differentiate E/M Services
Question: The gastroenterologist saw a new patient with rectal bleeding. She provided an E/M service [...] - Reader Questions:
Link Initial, Subsequent Procedures with Modifier 78
Question: A patient has hemorrhoids and my gastroenterologist cauterizes three internal hemorrhoids with a heater [...] - Reader Questions:
Face Time Is Essential to Established Patient
Question: Our practice performed a test on a patient who was referred to us by [...]
