krystim1109
Contributor
Hello
I want to code 44377 43239-59 43255-59. NCCI edits state mod 59 is allowed, however AMA states not to code 43239 43255 with 44377. So my question is - does the biopsy of the small bowel endoscopy 44377 include the EGD esophagus biopsy 43239 and angioectasias of gastric hemorrhage control 43255 ?
The enteroscope was introduced through the mouth and advanced to the proximal ileum. After
sedation, the Olympus SIF-Q180 and single balloon overtube were inserted through the mouth and
advanced to the jejunum/proximal ileum under direct visualization using standard single balloon
enteroscopy technique. Retroflexion was performed in the stomach. The small bowel enteroscopy was
accomplished without difficulty. The patient tolerated the procedure well.
The esophagus was notable for irregular z-line at 41cm. Esophagus examined with WL and NBI.
There was also nodular mucosa on the cardia side of the GEJ. Biopsies were taken with a cold
forceps for histology at 39, 40 and 41cm in four quadrants. Wide Area Transepithelial Sampling
(WATS-3D Brush Biopsy) was performed for histology and samples sent for Computer-Assisted 3-
Dimensional analysis. Separately, biopsies obtained from cardia.
Findings:
- The stomach was notable for moderate-severe erythema in the antrum with several 1-2mm
angioectasias. These were treated with APC. Random antral biopsies obtained.
- There was no evidence of significant pathology in the entire examined duodenum.
- The proximal ileum appeared normal. The furthest area reached was tattooed as follows. Area was
successfully injected with 5 mL India ink for tattooing.
- The small bowel contained one sessile, non-bleeding polyp with a small central erosion. The polyp
was 5 mm in diameter. The polyp was removed with a cold snare. Resection and retrieval were
complete.
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I want to code 44377 43239-59 43255-59. NCCI edits state mod 59 is allowed, however AMA states not to code 43239 43255 with 44377. So my question is - does the biopsy of the small bowel endoscopy 44377 include the EGD esophagus biopsy 43239 and angioectasias of gastric hemorrhage control 43255 ?
The enteroscope was introduced through the mouth and advanced to the proximal ileum. After
sedation, the Olympus SIF-Q180 and single balloon overtube were inserted through the mouth and
advanced to the jejunum/proximal ileum under direct visualization using standard single balloon
enteroscopy technique. Retroflexion was performed in the stomach. The small bowel enteroscopy was
accomplished without difficulty. The patient tolerated the procedure well.
The esophagus was notable for irregular z-line at 41cm. Esophagus examined with WL and NBI.
There was also nodular mucosa on the cardia side of the GEJ. Biopsies were taken with a cold
forceps for histology at 39, 40 and 41cm in four quadrants. Wide Area Transepithelial Sampling
(WATS-3D Brush Biopsy) was performed for histology and samples sent for Computer-Assisted 3-
Dimensional analysis. Separately, biopsies obtained from cardia.
Findings:
- The stomach was notable for moderate-severe erythema in the antrum with several 1-2mm
angioectasias. These were treated with APC. Random antral biopsies obtained.
- There was no evidence of significant pathology in the entire examined duodenum.
- The proximal ileum appeared normal. The furthest area reached was tattooed as follows. Area was
successfully injected with 5 mL India ink for tattooing.
- The small bowel contained one sessile, non-bleeding polyp with a small central erosion. The polyp
was 5 mm in diameter. The polyp was removed with a cold snare. Resection and retrieval were
complete.
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