Lower Endoscopy Coding: Reporting Lower GI Scope? Wait Till You Get the Big Picture (July 2010)
Highlighting how far the scope goes could be your clue.
Colonoscopy is not the only lower endoscopic procedure that a physician can consider for her patient. The three other endoscopic procedures of the lower gastrointestinal tract are just as important.
Here are 3 ways to approach coding a lower GI scope.
Seek Out 46600-46615 for Anoscopy
Scenario 1: A patient presents to your practice complaining of intermittent bright red blood in the stool. The gastroenterologist believes persistent hemorrhoids are [...]
Diagnosis Coding: 3 Tips Clear Up Your Dysphagia Coding Woes (July 2010)
Make sure you specify type.
Diagnosing dysphagia is often not cause for alarm among gastroenterology practices. Occasional difficulty in swallowing may simply occur when you eat too fast or don’t chew your food well enough. But persistent difficulty in swallowing may indicate a serious medical condition requiring treatment. For diagnostic gastroenterology, dysphagia is considered as an important symptom for diseases of the esophagus.
If you’re not careful enough, you might get lost on the sea of options [...]
Modifiers: Follow 5 Steps for Modifier 22 Claim Success (July 2010)
Your documentation determines the ‘unusuality’ of the situation.
Payoff: The Medicare rate for dysphagia treatment is about $102 (based on RVU of 2.77 and a conversion factor of $36.8729). The treatment plan for dysphagia can include further diagnostic testing, diet/liquid modifications, oral motor exercises, deep pharyngeal neuromuscular stimulation (DPNS), or neuromuscular electrical stimulation (NMES).
3. Support Treatment Code with DPNS Therapy
Since treatment for pharyngeal dysphagia (787.23) could involve DPNS therapy (direct neuromuscular stimulation to the pharyngeal musculature), [...]
You Be the Coder: Get Your Tube Fix Claim Right Using Descriptor as Key (July 2010)
Question: Our gastroenterologist treats a patient whose gastrojejunostomy tube has migrated to his stomach. The gastroenterologist perfoms a problem focused interval history and exam, after which he decides to perform an esophagogastroduodenoscopy (EGD) to reposition the tube. How should I code this scenario, considering there’s no code for repositioning a G tube?Kentucky Subscriber
Answer: Based on the scenario given, the patient’s percutaneous jejunostomy tube (J tube) slipped and became a percutaneous gastrostomy tube (G tube). [...]
Reader Questions: Look To 99211 for New-Med Regimen Encounters (July 2010)
Question: The gastroenterologist sees an established patient with a plan of care in place for her gastroesophageal reflux disease (GERD). Two weeks ago, the gastroenterologist started her on Nexium (esomeprazole). During the visit, one of our nonphysician practitioners (NPPs) evaluates the patient, taking blood pressure and other vitals. She also asks the patient if she has experienced side effects since she started Nexium. The patient reports that she has “thrown up three or four times” [...]
Reader Questions: Give pH Monitoring a New Treatment (July 2010)
Question: I can’t find a CPT that takes into account the prolonged nature of a seven-hour pH electrode test for GERD. How should I report it?
Oregon Subscriber
Answer: You will not find a code describing prolonged pH electrode testing for gastroesophageal reflux disease (GERD) because CPT eliminated that code in 2005.
You should now report all catheter pH-monitoring sessions with 91034 (Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode[s] placement, recording, analysis and interpretation). For instance, [...]
Reader Questions: Report External Hemorrhoid Removal with 3 Options (July 2010)
Question: I heard gastroenterologists sometimes treat external hemorrhoids, aside from treating internal ones. Can you enlighten me further about this procedure?
Vermont Subscriber
Answer: You heard it right. Gastroenterologists may treat patients with internal hemorrhoids, as well as patients with an external case. Your physician may treat the patient with an incision, in which you should report 46083 (Incision of thrombosed hemorrhoid, external). If the physician treats the patient’s hemorrhoids with cauterization, report hemorrhoidectomy (46250-46262), which is [...]
Reader Questions: Make Sure 3 Conditions Fit For 91065 (July 2010)
Question: My gastroenterologist performs a hydrogen breath test for fructose intolerance. What CPT should I use to report the procedure?
Nevada Subscriber
Answer: For any of these conditions: fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit, you may report 91065 (Breath hydrogen test [e.g., for detection of lactase deficiency], fructose intolerance, bacterial overgrowth, or orocecal gastrointestinal transit).
Remember, 91065 is exclusive to the conditions listed in the code description, and doesn’t include H. pylori breath test analysis.
Quick fact: [...]
ICD- 9 2011 UPDATE: Prepare to Get Specific With New Fecal Incontinence Codes for 2011 (June 2010)
Personal history, fecal impaction codes round out list of gastroenterology diagnosis changes.
Every October 1, you’re faced with new diagnosis codes, code deletions, and code revisions.
This year is no exception, with new congenital malformation, fecal incontinence, and body mass index diagnosis codes to learn. Save yourself the hassle of scouring the full list, and focus on this rundown of the changes that may affect your gastroenterology practice. Turn to New Secondary Diagnosis Codes
The first set of [...]
Removing or moving foreign body – the answer will lead you to two different codes.
Deciphering whether your gastroenterologist removes a foreign body or simply moves it will determine which code you should report for the procedure. Ensure you’re reporting foreign body removal (FBR) procedures appropriately, by knowing three facts.
1. Use 43247 for FBRs With a Scope
If your gastroenterologist actually performs an FBR – in other words, he extracts the foreign body – you should report this using [...]
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