Wiki Dx Colonoscopy - EMR ( Endoscopic Mucosal Resection) Techniques

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SamanthaLunde

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Hello!
I would greatly appreciate some help finding sources to clarify required verbiage in order to meet a 45390 for endoscopic mucosal resection. Our whole coding department is looking for some clarity as some of our providers tend to be vague case by case. My understanding is that AAPC recommends the lift, demarcate, piecemeal, and APC/cautery type description. I cannot seem to find this on AAPC or elsewhere (coding corner, ASGE, etc.) and I have not found clear answers for what might fall short. At times, depending on documentation, we are looking at a 45385, 45381-59 for the same lesion if it doesn't quite meet the language we are looking for at this time. Any information or resources would be appreciated. Thanks!
 
Endoscopic mucosal resection (EMR [eg, code 45390 with colonoscopy]) includes cap-assisted or ligation-assisted (banding) removal of a lesion, along with injection-assisted snare removal techniques. Whether performed in the upper or lower gastrointestinal tract, EMR requires the lift technique to create a space beneath the lesion to isolate the lesion from underlying submucosa, and the use of a specialized device to isolate the tissue to be removed. Coding for EMR procedures requires the performance of (1) a submucosal injection to lift the lesion; (2) demarcation of the lesion, often by creating a pseudopolyp out of tissue or any technique (including high definition white light, narrow band imaging, or by cautery) that allows clear visualization of the boundaries of the lesion; and (3) endoscopic snare resection. If all three components are not performed, it is not appropriate to report an EMR procedure.
 
Hello Our vagueness is in the demarcation of the lesion/s. They do not state that this was specifically done but they state that by adding the type of instrument that they use is enough as the endoscope uses 'white light' which isolates the lesion. I don't feel that this is enough but others agree the other way. thoughts? thank you
 
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