General Surgery Coding Alert

Question: Our surgeon performed an endoscopy, viewing the esophagus, stomach, and duodenum before identifying and removing a blockage containing a small ball from a child's jejunum. Should we report 43247 since the code states either duodenum and/or jejunum?

Tennessee Subscriber

Answer: No, the correct code for the foreign body removal in the jejunum is 44363 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of foreign body).

Although 43247 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with removal of foreign body) states"duodenum and/or jejunum as appropriate," the code takes into account situations where the stomach enters directly into the jejunum due to a prior bypass procedure.

Anatomy refresher: The small intestine begins with the duodenum (about 12 inches) before connecting with the jejunum (about 8 ft.) and finally the ileum (about 11 ft.). For a child without altered anatomy, you should choose the enteroscopy code rather than the upper gastrointestinal endoscopy for the service you describe. Once the surgeon passes the scope beyond the second portion of the duodenum into the jejunum to remove the foreign body, you should report 44363 instead of 43247.