General Surgery Coding Alert

Question: Our surgeon arranged to meet his patient, who had a foreign body stuck in his esophagus, in the ER. After an examination, the patient was transferred to another facility, where the same surgeon performed an EGD with removal of foreign body. This is a Medicare patient. How would we code this situation, since both services were performed on the same day?

Anonymous Subscriber CO

Answer: Since the surgeon met his patient in the ER, he would code the examination with an emergency department E/M code (99281-99285). The precise code used would depend on the level of E/M that was provided, based on history, examination and complexity of medical decision-making. The E/M code would be accompanied by a -25 modifier (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

The physician would also use a second, separate claim form to bill for the EGD. If the endoscopy went below the esophagus for diagnostic purposes, code 43247 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). If, on the other hand, the endoscopy was used only in the esophagus, code 43215 (esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) would be used.

Had they tried the endoscopy in the first facility before deciding to transfer the patient, modifier -53 (discontinued procedure) would have been attached on the first claims form to either the 43247 or 43215, as appropriate.

ICD-9 diagnosis code V64.3 (surgical or other procedure not carried out because of other reasons) also would need to be included. For the procedure, ICD-9 code 935.1 (Foreign body in esophagus) would be used.