Remain optimist for a potential $345 payment by easily navigating through the ins and outs of EGD coding. All you need to do is take a look at this op note where a gastroenterologist performed a conventional EGD with sedation, and find out.
Op note: Informed consent was achieved. The patient was cautiously premedicated with a total of 5 mg of Versed intravenously given in careful titration before and during the procedure.
The adult fiberoptic gastroscope was passed into the esophagus under direct vision minus complications. All areas were carefully assessed. The esophagus seemed like normal. The GE junction was at around 40 cm. There was no endoscopic proof of Barrett's esophagus. Manifold four-quadrant biopsies were obtained. Next the stomach was examined. There superficial ulcerations of the antrum consistent with NSAID ulcerations. Manifold biopsies were obtained. The body of stomach was normal and retroflexion pointed toward a normal cardia and fundus. Biopsies of the antrum and body of the stomach were obtained for CLO test to assess for H. pylori. The duodenal bulb was normal and the second portion of the duodenum too was normal. The patient tolerated the procedure well without difficulty.
While coding an upper GI endoscopy, take these three factors into consideration:
The type of dilator used by your doctor (if she carried out dilation at all) In this instance, the op note clearly states that she examined the patient for signs of Barrett's esophagus and took biopsies; assessed the stomach and took biopsies; prior to finally examining the duodenum. There you should report the procedure with 43239. If the doctor only examined the esophagus, you would choose from the esophagus endoscopy code set 43200-43232.
Advantage: If the procedure was performed in the office, you should anticipate to collect $345.20 as national rate for your claim using 43239.
Use 531.90 to report the primary diagnosis. If you know from the history what medicine the patient use, you may add V58.64 as secondary diagnosis.
Do not disregard biopsy, polyp treatment during EGD
It is important that you know of what your gastroenterologist did while carrying out the EGD on the patient. Say for instance, with biopsies remember that no matter how many biopsies a physician takes during the endoscopy, you can only code one procedure (43239 in this instance). But then an exception allows you to bill 43238 if the physician also carried out ultrasound guided aspiration on a separate anatomical site.
Note of caution: Do not mistake collection of samples from performing a biopsy. Usually doctors collect samples of fluid or superficial tissue cells during an EGD. This service is covered in the base procedure 43235. On the contrary, physicians would carry out an EGD with biopsy of any abnormality directly through the endoscope of suspected Barrett's esophagus or duodenal and stomach ulcers.
Many a time the doctor would treat polyps or other lesions during an EGD. For lesion removals, you have three CPTs to choose from: 43250, 43251, 43258.
With lesion removal, you can only report one EGD. But then, if the physician treats different lesions with different procedures, you could add modifier 59 to the procedure of lesser value to break the bundle.
For more on this and for other specialty-specific articles to assist your gastroenterology coding, sign up for a one-stop medical coding guide like Supercoder.
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