Gastroenterology Coding Alert

Hint: The type of scope your gastro uses could change the code completely Picking your lower endoscopy code doesn't have to be rocket science if you zoom in on the right items. According to Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta, when reporting lower gastrointestinal endoscopic procedures, you need to scan the note for the following facts: • the approach method • the length of scope insertion • what the doctor did through the scope • the patient's diagnosis. • the type of scope the doctor used If you address these five areas before sending out lower GI endoscopy claims, you stand a greater chance at success with payers. Identify the Approach Method The initial step in coding a GI endoscopy is identifying whether the procedure is an upper or lower GI endoscopy, says Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis.
Main difference: With upper GI endoscopies, the physician most often inserts the endoscope in the patient orally. With lower GI endoscopies, the approach is via the anus, Rasmussen says. Example: If the op note states, "Inserted endoscope anally in Patient X," the procedure would be a lower GI endoscopy. Place Importance on Scope Length and Type Once you have decided that a procedure is a lower GI endoscopy, you can begin searching the notes for an indication of how far the gastroenterologist inserted the scope into the patient, Rasmussen says. For lower GI endoscopy, you need to know the insertion's extent to choose between four separate code sets. Focus on how far the gastroenterologist inserted the endoscope. According to Rasmussen, if the gastroenterologist examines the:  • anus (up to 5 cm of insertion), you should assign a code from the anoscopy code set: 46600 (Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) to 46615 ( ... with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique). • anal canal, rectum and the sigmoid colon (6-25 cm), choose a proctosigmoidoscopy code: 45300 (Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) to 45321 (... with decompression of volvulus). Red flag: Your gastroenterologist will need to indicate the type of scope he used (such as rigid versus flexible), Parks says. • entire rectum, sigmoid colon, and/or performs an exam of a portion of the descending colon up to the splenic flexure (26-60 cm), report a sigmoidoscopy code: 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) to 45339 (... with ablation of tumor[s], polyp[s], or other lesion[s] not amenable [...]