Gastroenterology Coding Alert

Question: My physician has given me charges for a patient whom he saw in the ER for foreign body in esophagus. The ER visit led to an EGD with foreign body removal, which in turn led to a dilatation (CRE). How should I report this?

Nevada Subscriber

Answer: Code correctly with the following:

• 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity.), appended by modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) for the ER visit;
• 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/ or jejunum as appropriate; with removal of foreign body) for the EGD with FB removal;
• 43249 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/ or jejunum as appropriate; with balloon dilation of esophagus [less than 30 mm diameter]) for the EGD with dilatation;
• 935.1 (Foreign body in esophagus) linked to 99283 and 43247;
• 530.3 (Stricture and stenosis of esophagus) linked to 43249.

Caution: Don't append modifier 59 (Distinct procedural service) on the dilation code 43249. CPT®s 43247 and 43249 are not bundled in CCI edits or by any commercial carrier.