Gastroenterology Coding Alert

Question: What should I use for argon plasma coagulation (APC)? The patient has a GAVE lesion that wasn't actively bleeding at the time of the procedure but has bled in the recent past. The physician is trying to obliterate the lesion. Should I use 43258 or 43255?

Georgia Subscriber

Answer: "Obliterate" or "ablate" means to destroy the lesion. Therefore, you should use 43258 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique).

You should not use 43255 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method) because this code describes the control of bleeding that is active. This case describes the destruction of the lesion that might be a cause of prior bleeding or might bleed while the gastroenterologist is destroying it.