General Surgery Coding Alert

Use caution for scopes in the same family, experts say When your surgeon performs several scopes on the same day, you'll need to know whether one of the endoscopes was a base procedure to bill these services correctly. Experts offer four basic pointers to guide your multiple endoscopy billing. 1. Look to CPT for Scope 'Families' Before worrying about how to apply the multiple endoscopy rule, you must first know why and when it applies.
 
The multiple endoscopy rule is CMS' method to avoid paying twice (or more) for "inclusive" services by reimbursing only a portion of any endoscope performed at the same time as another endoscope of the same basic type, says Tara L. Conklin, CPC, an instructor for CRN Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, outpatient coding certification and inpatient coding certification.
 
Here's how the rule works: CPT divides groups of similar codes into so-called "families." The first code (the base or "parent" code) describes the basic procedure. Following the base code, CPT lists any variants that "go beyond" the base code. The text definitions for these follow-up codes are indented to show their relation to the parent code, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. The definitions include any text in the parent code prior to the semicolon. For example, consider this partial code family:

45330 - Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
45331- ... with biopsy, single or multiple
45332 - ... with removal of foreign body
45333 - ... with removal of tumor(s), polyp(s) or other lesions(s) by hot biopsy forceps or bipolar cautery.   In this case, 45331, 45332 and 45333 describe more extensive procedures than the base code, 45330, which they are listed under. In other words, 45331, 45332 and 45333 include all the work involved in 45330 plus something more.
 
The multiple endoscopy rule applies only if two or more endoscopies the surgeon performs are members of the same code family, Conklin says. If the surgeon performs 45331 and 45333 during the same operative session, the multiple scope rule applies. But if he or she performs 45331 and a scope from a different code family, such as esophagoscopy with biopsy (for example, 43202), you need not worry about the multiple scope rule.

2. Always Include the 'Base' Procedure Let's assume that the physician has performed a diagnostic sigmoidoscopy (45330) plus sigmoidoscopy with control of bleeding (45334). How does the multiple scope rule apply?
 
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