Gastroenterology Coding Alert

Question: Can I report ablation with other esophagogastroduodenoscopy (EGD) procedures?

Kansas Subscriber

Answer: Yes but be careful. You’ll need to pay close attention to NCCI edits (and of course, the procedure notes) to be sure you’re coding correctly.

When your gastroenterologist performs multiple EGD procedures, multiple endoscopic payment rules will apply. If your clinician is performing other EGD procedures in the same session in which he performs an ablation, you will also need to pay attention to the NCCI edits.

Some of the EGD procedures that run into edits with 43270 include:

• 43250 (Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps)
• 43251 (…with removal of tumor(s), polyp(s), or other lesion(s) by snare technique)
• 43255 (…with control of bleeding, any method)

All the above-mentioned edits carry a modifier indicator of “1,” which means that you can separate the codes with a suitable modifier such as 59 (Distinct procedural service). So if, for example, your gastroenterologist performs removal of a polyp by ablation and removal of another polyp by snare technique in a different location, you can report both 43251 and 43270. You will have to append modifier 59 to 43251.

Exception: If your clinician ablates a tumor or polyp and, during the procedure, encounters ablation-related bleeding and controls it with a plasma coagulator, then you cannot report 43255 for the bleeding control. In this case, the bleeding control is part of the polyp removal procedure and therefore cannot be reported separately. But if the polyp removal and the bleeding control were in two different sites, you can use the modifier to separate the codes and report them separately. Be sure to provide documentation supporting your claims when you do so.