Gastroenterology Coding Alert

Question: If, during an endoscopy procedure, the doctor accidently tears the esophagus and places a clip on that tear, can we bill for that? If so, which code applies?

Codify Subscriber

Answer: Unfortunately, you cannot report this service, and no code will allow you to collect for it if the physician caused the tear. The code you report for the procedure itself covers any tears that the physician causes and must repair.

“Control of bleeding caused by an endoscopic procedure is bundled into every procedure,” said the American Society for Gastrointestinal Endoscopy in its 2016 Coding Update. “However, for control of bleeding for a separate site/lesion, use modifier 59 with 43255 (…control of bleeding…) in addition to the primary procedure.” The same concept applies to injuries requiring endoscopic clipping or suturing.