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General Surgery Coding Alert

Reader Question:

GI Bleed Can Mean a 2-Code Colonoscopy Claim

Published on Mon Jul 26, 2004

Question: Our surgeon performed a colonoscopy, during which he removed a polyp using the snare technique in the transverse colon. He also used bipolar cautery to stop gastrointestinal bleeding. How should I code for this scenario?

Missouri Subscriber

Answer: As long as your documentation proves two separate sites, this is a two-code claim -- but make sure you remember your ICD-9 codes. You should:

  • Report 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) with the proper ICD-9 code to reflect the site that was actively bleeding.Depending on the operative note specifics, some suitable diagnosis codes for this situation might be 569.82 (Ulceration of intestine), 569.83 (Perforation of intestine), 569.84 (Angiodysplasia of intestine [without mention of hemorrhage]), or 569.85 (Angiodysplasia of intestine with hemorrhage).

  • Attach modifier -59 (Distinct procedural service) to 45385 (... with removal of tumor[s], polyp[s] or other lesion[s] by snare technique) to show that 45382 and 45385 occurred at different sites. If you report the lower-valued code (45385) alone and the higher-valued code (45382) with modifier -59 attached, you will lose money because the carrier reimburses fully for the stand-alone code and reduces reimbursement for the code with -59 attached.

  • Include ICD-9 code 211.3 (Benign neoplasm of other parts of digestive system; colon). Modifier -59 shows that the surgeon treated two separate injuries.

    Remember: Code order is a vital concern in successful modifier -59 coding. The RVUs for 45385 are 7.72 for facilities and 13.33 for nonfacilities, while 45382 is worth 8.24 for facilities and 15.73 for nonfacilities.

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