Reader Question: Removal of Bile-Duct Sludge   (December 2001)

Question: How should I code for an ERCP with an extension of sphincterotomy, removal of common bile-duct sludge, and the placement of a stent? Is sludge considered a foreign body? Is an extension of sphincterotomy the same as a sphincterotomy?Virginia Subscriber
Answer: The original placement of an ERCP stent is reported with 43268 (ERCP with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct). If this is a stent replacement, there are many [...]

Reader Question: Dry Paracentesis   (December 2001)

Question: Our gastroenterologist performed a paracentesis (49080) but didnt get any fluid even though he went to three different sites. Should I bill this as a paracentesis or an attempted paracentesis?Minnesota Subscriber
 Answer: You should report this as a reduced service by attaching modifier -52 to the procedure code because no fluids were drawn. Its not uncommon for a paracentesis procedure to come up dry, and many insurers will pay the full fee in this situation, [...]

Reader Question: E Code for Postoperative Complications   (December 2001)

Question: A patient had an ERCP and was sent home. Our doctor issued a prescription for the drug Axid to treat an ulcer he found during the procedure. Patient later presents at the emergency department with nausea and vomiting, and our doctor was called in to examine her. I plan to use 787.01 (nausea with vomiting) as the primary diagnosis, but would it be appropriate to use E879.9 (other procedures, without mention of misadventure at [...]

Reader Question: Follow-Up or Varices Dx   (December 2001)

Question: Our doctor did a follow-up endoscopy to treat reoccurring varices. Upon examination, the patient has no obvious varices and no other symptoms, but does have hepatitis C with cirrhosis. An EGD with banding of varices was performed several months ago. What is the appropriate diagnosis code for this endoscopy? Should I use V67.59 (follow-up examination) because there were no symptoms? Or should I use 456.1 (esophageal varices without mention of bleeding) because the doctor [...]

Add-On Services Can Lift EUS Reimbursement by 30 Percent   (November 2001)

Gastroenterology practices that bill separately for services that are commonly performed during an endoscopic ultrasound examination (EUS), such as Doppler studies or a celiac nerve block, may be able to boost their payout for the procedure from 10 to 30 percent. This may help combat the lower reimbursement that some gastroenterologists experienced when new EUS codes were added to CPT 2001.  For some procedures,  additional EUS codes have made it easier for a gastroenterologist to [...]

Commercial Payers Likely To Reimburse India Ink Tattooing   (November 2001)

More gastroenterologists are finding that commercial payers will reimburse for India ink tattooing of lesions removed during endoscopies, especially if they take the time to document and support their insurance claims.  India ink tattooing consists of using a needle to inject India ink into a lesion and marking it permanently so a gastroenterologist or surgeon can easily identify the lesion later. “I use it to see if a polyp has been removed completely,” says Bergein [...]

You Be the Coder: Incomplete Colonoscopy With Biopsy   (November 2001)

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: A colonoscopy was planned for a patient, but the gastroenterologist could not advance the scope to splenic flexure due to poor patient preparation. A polyp was found and biopsied even though the colonoscopy was incomplete. Should I bill this as a flexible sigmoidoscopy with biopsy (45331) or as an incomplete colonoscopy (45380-53)? Georgia Subscriber

Answer: You [...]

CMS Releases ICD-9 Codes   (November 2001)

New diagnosis codes for constipation and esophagitis top the list of ICD-9 changes for 2002 of interest to gastroenterologists. CMS announced that the new codes may be used on medical claims as early as Oct. 1, 2001. Use of the codes is not mandatory until Jan. 2, 2002.  Gastroenterology practices may want to put off implementation of the new codes until January 2002, because many Medicare carriers and private payers will not have their computer [...]

Clarification: Catheters Considered EUS   (November 2001)

In the September 2001 issue of Gastroenterology Coding Alert, the following reader question was addressed: Our doctor performed a flexible sigmoidoscopy and the placement of a catheter into a fistula in the colon to obtain a fistulogram. This was done under ultrasonic guidance. Any suggestions on how to code the catheter placement and ultrasonic guidance?
Our coding expert suggested using 76999 (unlisted ultrasound procedure) in addition to the flexible sigmoidoscopy code 45330 to report these services. Rather than going through the extra [...]

Reader Question: Code for Endoscopic Hiatal-Hernia Repair   (November 2001)

Question: I have been presented with an endoscopic hiatal-hernia repair. Which CPT codes should I use to report this?Delaware Subscriber
 Answer: CPT has no specific code for the endoscopic repair of a hiatal hernia. Two new techniques, the Stretta procedure and endoluminal gastroplication, are often used by gastroenterologists to treat hiatal hernias and a related condition, gastroesophageal reflux disease.  The Stretta procedure uses radiofrequency energy delivered through needles to destroy nerves in the lower esophageal sphincter [...]