Wiki EGD with Stitch/Suturing CPT?

[clarkmegan]

Anyone have a CPT code for EGD with stitch/suturing to repair an esophageal perforation? I'm leaning toward 43499 but not sure if there's a better code.

 

[Aldandi]

Well Clark I would suggest to code for the unlisted one ie; 43499 since we donot have a particular CPT describing to the suture repair but also please make sure to check the following

Keep this CPT instruction in mind: "Don't choose a CPT code that merely approximates the service provided." This rule is key for compliant coding; however it leaves you with tough job of submitting a claim without a procedure-specific code.

When you file a claim using an unlisted procedure code you should include a cover letter stating why you are using the unlisted code. This separate report should explain in simple straightforward language exactly what the physician did.

In addition, you need to submit reporting documentation identifying the specifics of the procedure when you file the claim. The supplemental documentation should define the service (nature, extent, need) and the time, effort and equipment required. Other information to include:

• Was the procedure was independent of other services
• Did the doctor carried out additional procedures at the same site
• The number of times the doctor carried out the service at the encounter
• Any extenuating circumstances that complicated the service
• Diagrams or photographs to aid the person reviewing your claim better understand the procedure.

Unlisted procedure codes don't appear in the Medicare Physician fee Schedule, so they don't have assigned fees or global periods. Your payers will generally determine payment for unlisted procedure claims based on the documentation you provide. You can suggest a fee by comparing the unlisted procedure to a similar listed procedure with an established reimbursement value.

Hope this answers your question. Happy coding as always