Gastroenterology Coding Alert

Question: The gastroenterologist injected epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy (43239). How should I report this?

Hawaii Subscriber

Answer: The answer depends on what sort of bleeding your gastroenterologist treated. Go back to the procedure documentation and determine whether the ulcer was bleeding prior to the biopsy or if the biopsy caused the bleed. Then, choose from the following coding options based on the answer:

Option 1: If the ulcer was currently bleeding prior to the biopsy procedure and the gastroenterologist injected epinephrine to control the bleeding, then you should report the control of bleeding procedure. Report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) for the biopsy. Then, report 43255 (... with control of bleeding, any method) for the control of bleeding. Code 43255 accurately describes control of bleeding by "any method," including injection.

Option 2: You can't report control of bleeding if the gastroenterologist causes the bleeding. You should call on control-of-bleeding codes only "when treatment is required to control bleeding that occurs spontaneously, or as a result of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention," according to the AMA's Principles of CPT Coding. Therefore, if the biopsy of the ulcer caused it to bleed, then you can't bill for control of bleeding since this is considered standard of treatment during the procedure.

While it may seem unfair, the rule is that if the gastroenterologist caused the bleeding, then you cannot bill any work needed to stop the bleeding using a separate code or using a modifier on the primary code.