Coding Tips: Finesse Your Internal Hemorrhoid Removal Claims With These Pointers   (December 2011)

Removal method notes help guide you to the right code.When your gastroenterologist performs internal hemorrhoid removals in the office, you’ll stand a better chance of recouping for those services if you’ve looked closely at hemorrhoid location and specific removal method. Take this quick refresher on coding basics. Look for Location and Anesthesia to Ascertain TypeTo accurately report a hemorrhoid-related procedure, you should first identify the hemorrhoid type. Hemorrhoids are a plexus of veins present in [...]

ICD-10: ICD-10 Taps Z85.038 For Personal History of Colon Cancer   (December 2011)

Don’t expect any changes in the code’s descriptor when new system kicks off in 2013.If a patient has a personal history of colon cancer, it can significantly impact his risk of developing the condition. Usually, a high-risk patient would carry a medical history that includes polyps, inflammatory bowel disease, or certain colorectal cancers. Presently, with ICD-9, you code personal history of colorectal cancer with V10.05 (Personal history of malignant neoplasm of large intestine).ICD-10 difference: When [...]

You Be the Coder: Get Around Coding GAVE with Coagulation   (December 2011)

Question: If our gastroenterologist is treating a condition of gastric antral vascular ectasia, not bleeding, using the argon plasma coagulator, how do I code it?Alaska SubscriberAnswer: Gastric Antral Vascular Ectasia (GAVE) is a condition that is often referred to as “watermelon stomach” due to the distinct watermelon-like appearance it provides to the stomach lining when it is observed using an endoscope. This is basically a type of arteriovenous malformation (AVM) that has a tendency to [...]

Reader Question: Do Not Ignore Colonoscopy with Negative Findings   (December 2011)

Question: Our gastroenterologist performed a colonoscopy on a patient with a prior history of colon cancer (asymptomatic at present). There were no negative findings with the colonoscopy. A colonoscopy done four years prior to this also had no findings of significance. How should I code this?New York SubscriberAnswer: Since the patient has a previous history of colon cancer, the diagnosis should be coded as V10.05 (Personal history of malignant neoplasm of large intestine). Since the [...]

Reader Question: Epinephrine Injections with Colonoscopy? Not So Fast   (December 2011)

Question: Prior to taking biopsy samples of polyps, our gastroenterologist injected epinephrine to the site to prevent bleeding. Can this be coded with 45381? There was no bleeding during or after the procedure.Ohio SubscriberAnswer: The injection of epinephrine to the site prior to taking biopsy samples will be considered as part of the biopsy procedure and should not be coded under 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s] any substance), as [...]

Reader Question: Report Unsuccessful Snare for Polyp Removal   (December 2011)

Question: Our gastroenterologist attempted polyp removal using a hot snare. However, the procedure was stopped midway and resection was not possible. Can I code this with 43239 with modifier 52 appended?California SubscriberAnswer: Since your gastroenterologist attempted polyp removal using a snare, you cannot code it with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple). Instead, you need to code it with 43251 (Upper [...]

Reader Question: Identify Site, Procedure for Banding Hemorrhoids   (December 2011)

Question: At our ASC, our gastroenterologist is planning to attempt banding of hemorrhoids. Can you tell me what the global period for this procedure is? Also, can you tell me how to code for this procedure so that there are no complications with billing and insurance? Will the code vary if the physician is banding more than one hemorrhoid?Florida SubscriberAnswer: The global period for banding of hemorrhoids is 10 days. Since rubber band ligations are [...]

Reader Question: 99238 Without a Face-to-Face? Think Again   (December 2011)

Question: Our gastroenterologist could not provide a face-to-face discharge for a patient. Can we charge 99238 as he provided instructions on the day prior?Minnesota SubscriberAnswer: If your gastroenterologist did not perform a face-to-face service on the day of discharge, then you cannot charge 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (Hospital discharge day management; more than 30 minutes).However, since he saw the patient on the day prior to discharge, you can [...]

Reader Question: Should Tube Removals be Conjoined to The E/M Service   (December 2011)

Question: In the examination room of our hospital, if our gastroenterologist performs a tube removal, should this be included in the E/M or should it be reported separately under a different code? Also, is it necessary for the hospital to report the E/M service separately?Utah SubscriberAnswer: A tube removal performed should be included in the E/M only and need not be reported separately. The level of service for the E/M code will be determined by [...]

Reader Question: Base Billing Order on RVU Order   (December 2011)

Question: I know that as a general rule the highest RVU has a higher billed amount and that when you bill you should always put the highest amount first. But when it comes to bilateral surgeries is it true that you would sometimes be prudent to put another procedure first because a bilateral code that was done bilateral/unilateral would still be paid at a reduced allowable? Texas SubscriberAnswer:  Yes, you should sometimes put another procedure first. [...]