Gastroenterology Coding Alert
Separate Documentation Important for Modifier 62
Question: Recently, our gastroenterologist performed an EGD during the same session in which a surgeon placed a PEG tube. How should we report this? Should we bill 43246 with modifier 62, or should we report 43235 for our portion of the procedure and let the surgeon report 43750 separately for his portion? Answer: You-re probably more correct to report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) with modifier 62 (Two surgeons).
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In this case, each physician performed a distinct component of a single procedure. Reporting 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the GI doctor and 43750 (Percutaneous placement of gastrostomy tube) for the surgeon would probably constitute unbundling, according to most payers.
For a co-surgery claim to work, however, the two physicians must coordinate their billing strategies. This requires three steps:
1. Because co-surgeons each perform a distinct part of the procedure, they can't share the same documentation. Each physician should provide a note detailing which portion of the procedure he performed, how much work was involved, and how long the procedure took.
2. Each physician should identify the other as a co-surgeon.
3. The co-surgeons should link the same diagnosis to the common procedure code.
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