Gastroenterology Coding Alert

Question: My gastroenterologist introduced an endoscope through the mouth and advanced it to the duodenal bulb. According to his report, the endoscopy was technically difficult and complex. He found a complete obliteration at the upper esophageal stenosis at upper endoscopy. He pulled the G tube and passed the endoscope pre the stoma retrograde to a complete stenosis. The length of stenosis appeared short (1-2 cm) with both scope and under fluoroscopy. He made multiple punctures with a 23-gauge needle. He finally replaced the G tube with a 22 french tube. How should I report this?Arizona SubscriberAnswer: You should report this service with 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). To account for the extra work, you should append modifier 22 (Increased procedural services).Keep in mind: The key to collecting reimbursement for increased procedures is all in the documentation. Sometimes a physician will tell you he did "x, y, and z," but when you look in the documentation, the support isn't there. Documentation is your chance to demonstrate the special circumstance that warrant modifier 22.You should also report 76000-26 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]; professional component).Your diagnoses should be V55.1 (Attention to artificial openings; gastrostomy) and 530.3 (Stricture and stenosis of esophagus).