Gastroenterology Coding Alert

Question: An established patient reports to the gastroenterologist complaining of a burning pain in his abdomen and frequent belching. During a level two E/M service the gastroenterologist begins to suspect an H. pylori infection. The gastroenterologist performs an inoffice endoscopy with biopsy (we own the testing equipment and have a CLIA waiver). She then interprets the test results, which confirm the condition. Is the test interpretation part of the screening?

Missouri Subscriber

Answer: Payers consider the biopsy interpretation a separate service when the gastroenterologist tests for H. pylori via endoscopy. On the claim, report the following:

• 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) for the EGD

• 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making ...) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99202 to show that it was a separate service from the endoscopy

• 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate) for the interpretation

• modifier QW (CLIA waived test) appended to 87077 to show the payer that you have a Clinical Laboratory Improvement Amendment [CLIA] waiver

• 041.86 (Other specified bacterial infections; Helicobacter pylori [H. pylori]) linked to 43239, 99202, and 87077 to represent the patient's condition.