Gastroenterology Coding Alert

Question: A patient has a hiatal hernia with a Mallory-Weiss tear and upper gastrointestinal bleeding. My physician performs an EGD and removes a blood clot. How should I code this?

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Answer: There's no code specific to removing blood clots during an upper gastrointestinal endoscopy, so, if no other maneuver was performed to stop the bleeding, you'd code 43235 (Upper gastrointestinal endoscopy including esophagus,

stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). If your physician did anything to stop or treat the bleeding site, you would

instead code 43255 (...with control of bleeding, any method). If you've got good documentation of the additional time and effort involved in clearing the blood clot, you may append modifier 22 (Increased procedural services).

Do your homework: But don't expect an easy go of it from your insurer. Payers won't accept a modifier 22 claim without convincing evidence that the procedure was out of the ordinary. Some procedures go smoothly, others are more difficult;

the relative value units (RVUs) assigned to CPT codes assume that the "easy" and "hard" procedures will average out over time.

Diagnoses: For the Mallory-Weiss, you'll code 530.7 (Gastroesophageal laceration-hemorrhage syndrome) and for the hernia you should code 553.3.