Gastroenterology Coding Alert

Question: Our physician performed two upper gastrointestinal endoscopies (EGDs) on the same patient during the same encounter. He performed the first EGD to remove two polyps by snare technique, and the second EGD was a biopsy in a separate gastrointestinal area. Can we report both EGDs in this situation? What about a separate E/M service?

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Answer: Yes, you can report both EGDs, but you'll have to leave E/M codes off the claim.

When a physician performs multiple EGDs, one of those procedures is usually an EGD with biopsy, as is the case in this example.

On your claim:

• report 43251 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) for the removal of the polyps. (Note: Report 43251 only once per encounter, regardless of the number of polyps the physician removes.)

• report 43239 ( ... with biopsy, single or multiple) for the EGD with biopsy.

• attach modifier 59 (Distinct procedural service) to 43239 to show that the polyp removal and the biopsy were separate services.

You should be paid fully for 43251 and will get reduced reimbursement for 43239.