Gastroenterology Coding Alert

To make sure you know how to incorporate the latest National Correct Coding Initiative edits into your everyday coding, take a shot at coding each of the following scenarios. Compare your coding solutions to those provided below.
 
Scenario 1: A patient presents for placement of a PEG tube. The gastroenterologist places the tube and also removes an old PEG tube.

Scenario 2: A patient presents for an endoscopy. During the procedure, the gastroenterologist collects a portion of a stomach lesion for biopsy.

Scenario 3: A patient presents for placement of a PEG tube. During the procedure, the gastroenterologist notices that the esophagus has a foreign object, which she removes. The doctor then places a PEG tube after removing an old PEG tube.
 
Scenario 4: A patient presents for a standard endoscopic retrograde cholangiopancreatography (ERCP). Multiple biopsies are taken during the procedure, and fluoroscopy is also used. Check Yourself Answer 1: Code only 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Remember, you can report standard PEG replacement only once per patient encounter.
 
Answer 2: Code only 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) for the endoscopy. You should not separately report the biopsy.

Answer 3: For the PEG tube replacement, report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Under these circumstances you should separately report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body) for the object removal. Append modifier -59 (Distinct procedural service) to the latter code to indicate to the carrier that you should be reimbursed for both procedures because the gastroenterologist performed them.

Answer 4: Code only 43261 (ERCP; with biopsy, single or multiple) for the ERCP. NCCI now officially bundles fluoroscopy into all ERCP codes (43260-43272).