Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed an EGD on a Medicare patient that was already bleeding when the doctor did the procedure. During the EGD, two angiodysplastic lesions with bleeding were found. Our clinician achieved coagulation using a bipolar probe. So can I code for Medicare, 43255-59 and 43258?

Illinois Subscriber

Answer: You will have to base your reporting for the procedure on what your clinician intended to do. If your gastroenterologist performed the EGD to stop the bleeding then identified the cause and treated the angiodysplastic lesions, you will only have to report 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method) for the procedure that your clinician performed.

If on the other hand, your clinician wanted to obliterate the non-bleeding lesions using the bipolar probe, you will have to report the procedure using 43258 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique).

However, any control of bleeding that your clinician produced during the procedure cannot be reported additionally using 43255. You cannot use any modifiers such as 59 (Distinct procedural service) also to report this code. In such a scenario, the control of bleeding that your clinician caused will become part of the work described under 43258 and cannot be reported separately.