General Surgery Coding Alert

Question: A patient reported to the office for a colonoscopy, during which the surgeon used India ink to mark two lesions she removed by snare technique. Should I report the tattooing, or just stick with the base colonoscopy?

Montana Subscriber
 
Answer: The answer depends on whom you are reporting the service to. Medicare does not reimburse specifically for India ink tattooing. To further complicate things, there is also no specific CPT code for the procedure, leaving coders with few choices if they want reimbursement for India ink.

But there is a code for colonoscopy with injection -- and this could be your ticket to India ink payment. For the colonoscopy and the India ink tattooing, report only one code: 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance).

The National Correct Coding Initiative does not bundle 45381 to any other colonoscopy code. You may therefore report 45831 without a modifier. 

Medicare should reimburse for the additional injection service above the base colonoscopy code. But some commercial carriers may deny the additional service and claim that it is included in the higher-valued code.

You may also have to appeal a denied claim to receive full payment for a colonoscopy with India ink tattooing, at least initially. If you file an appeal, make sure to include a separate letter containing cost estimates of the procedure, including the materials and supplies the surgeon used and the additional nursing time required, if any.

An appeal takes a lot of time, but if you do it properly and the payer recognizes India ink tattooing once, the payer will more likely accept future tattooing claims on good faith. Of course, if a payer has laid out its reasons for not reimbursing India ink tattooing, stop coding for the procedure with that payer - unless you want auditors in your office.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, HIM program coordinator at Clarkson College in Omaha, Neb.