General Surgery Coding Alert

Question: While the surgeon was performing a colonoscopy on a patient, he noticed a lesion that he marked with an injection of India ink. What is the correct code(s) for this procedure?


Rhode Island Subscriber


Answer: There is a proper code to report, but your initial claims with India ink tattooing may not be fully reimbursed without an appeal.

On the claim, you should report 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance) for the colonoscopy with India ink tattooing.

Depending on the payer, the claim may be returned minus the India ink reimbursement. Most Medicare carriers will reimburse for the injection service above the base colonoscopy code. Some commercial carriers, however, may only reimburse for the base colonoscopy code (45378, ... diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]).

On appeal, deluge the payer with documentation to justify the extra reimbursement for India ink tattooing. Coders have been known to fortify India ink appeals with a separate letter laying out:
  cost estimates for the India ink tattooing 
materials and supplies used specifically for the tattooing
  extra nursing or surgeon time the ink tattooing required.
 
There's no getting around it - the appeals process is front-loaded with work for surgical practices. But an appeal is also back-loaded with potential reward, and all that work can make your practice more efficient and profitable in the future.

Remember, after you win an appeal with a payer for India ink tattooing, reporting it to that payer will be that much easier evermore.