Gastroenterology Coding Alert
Stent Placement Code Overrides Dilation
Question: I was coding a transendoscopic stent placement claim. The endoscopic report read, "Stenosis of pyloric channel and duodenal bulb ... significant gastric outlet obstruction, therefore balloon dilation carried out." Can I report both endoscopy codes with modifier -59 (Distinct procedural service) attached? Answer: You cannot report both procedures. On the claim, file only 43256 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement [includes predilation]).
Alabama Subscriber
Why? According to CPT 2004, "Do not report 43245 (... with dilation of gastric outlet for obstruction [e.g., balloon, guidewire, bougie]) in conjunction with 43256." Medicare will deny any claim for a single session that includes both 43245 and 43256.
Gastroenterology Coding Alert
- Coding Medicare Screening Services? Don't Forget V Codes
Code makes colorectal cancer screening claims rock-solid If you aren't reporting V codes on claims [...] - Don't Let Payer KO Your Conscious Sedation Claim
Some insurers will pay separate conscious sedation codes It's a fact: When the gastroenterologist administers [...] - You Be the Coder:
Can You Report E/M Service for Tube Removal?
Question: My gastroenterologist manually removed a percutaneous gastrostomy (PEG) tube from an established patient; this [...] - Note Every Detail to Ensure Sedation Claim Success
If you can't prove medical necessity, sedation payment is unlikely Getting separately reimbursed for conscious [...] - Coding Clarification:
Sigmoidoscopy Code and EGD
In the August 2004 issue of Gastroenterology Coding Alert, the article "Must-Know [...] - Reader Questions:
Leave Anesthetic Infusion Code off Hernia Claim - Reader Question:
If Doc Just Looks for Problem, Report Diagnostic Colonoscopy
Question: A patient with abdominal distention reported to the office. The gastroenterologist performed a colonoscopy [...] - Reader Questions:
Stent Placement Code Overrides Dilation
Question: I was coding a transendoscopic stent placement claim. The endoscopic report read, "Stenosis of [...] - Reader Questions:
Use Reason When Reporting After-Hours Care
Question: Our normal office hours are 8:30 a.m. to 5:30 p.m. Monday through Friday. Occasionally, [...] - Reader Questions:
Control of Bleeding Changes EGD Code Choice
Question: Our physician performed an EGD for a patient with upper gastrointestinal bleeding and bleeding [...] - News You Can Use:
Get Ready for Winter Rush of New CPT Codes
Despite loss of grace period, AMA won't release codes any sooner Gastroenterology coders might want [...] - Coders Must Provide Last Line Of Documentation Defense
Prove separate site before mailing modifier -59 claim As a coder in a busy gastro [...] - You Be the Expert:
What Is the Most Vital Info on a Claim?
Question: I am trying to come up with a list for my gastroenterologists to follow [...] - Reader Question:
Show Sloppy Doctor the Dangers of Bad Notes
Question: One of our gastroenterologists is driving the coding department crazy. Each operative report he [...]
