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Wiki Which would be the correct code?

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jdibble

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Asking for some help!

I do some coding for a GI doctor who does straight forward EGDs, however I have been asked to review a different doctors notes and I am not familiar with the procedure he did. I have tried to research this and the answers I have gotten are not clear. Could someone look at this and tell me would I use 43239 or 44361? The information I received for 44361 says that is can only be used if the doctor documented how far by cm into the Jejunum he went but this is the code he billed. Any information and guidance on how to code this is appreciated.

1595944043187.png



Thank you for any help with this!

Jodi
 
I think that because the code description for 44361 states 'beyond second portion of duodenum', and your report shows that the provider examined the jejunum, I believe this code is supported. I don't believe it would be necessary to know the exact measure given you already have this. I don't see anything in CPT or CPT Assistant's guidance stating that the measurement must be documented in order to be able to bill this code. Perhaps you could ask whomever gave you this information to provide you with their source?
 
This might help:

1596481986581.png



My two cents are I would select 43239 because they took multiple gastric biopsies so the intent of the surgery was not to specifically look at the small intestine.
 
Thank you for the responses. Of course both are different opinions and valid points! I will have to re-evaluate this information to decide which is the right code!
 
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