Gastroenterology Coding Alert

Question: I have a chart to code that has the following findings: "I found a bolus of meat in the distal esophagus which I pushed into the stomach. The patient has a sliding hiatal hernia and a Schatzki's ring." Should I code this as a foreign-body removal or a regular endoscopy? My understanding was that I could not code this as a foreign-body removal because the gastroenterologist did not take it out.

Utah Subscriber

Answer: Many clinicians and coding experts would argue that you are justified in reporting foreign-body removal (43247, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body). But -- as you note -- this would technically assume that the physician had removed the bolus from the patient's body entirely.

Clearly, however, the physician service in this case exceeds a simple diagnostic EGD (43235, ... diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

To err on the side of caution, your best solution is to report 43247 and append modifier 52 (Reduced services). Include a brief note with your claim explaining that the physician dislodged the bolus into the stomach using the endoscope rather than removing it from the body entirely.

Your pay shouldn't suffer: Common sense would suggest that the physician isn't really doing less work by "dislodging" the bolus than he would by "removing" it. By appending 52, you are following the letter of the coding guidelines, but in this case you really shouldn't expect the insurer to reduce payment for 43247.