Clip and Save: Capture HPI Elements Using These Questions   (June 2010)

Get your gastroenterologist to capture the information you need with this handy list.
When counting elements, check to see how many of these eight questions your gastroenterologist answers in the notes:What is the location of the problem? (location of pain, mass, or organ involved)What is the quality of the problem? (quality)How intense is the pain or problem? (severity)How long has the patient had the problem? (duration)Is the problem better or worse at any time of the [...]

You Be the Coder: Get To Know Most Frequent Multiscope Code   (June 2010)

Question: The gastroenterologist treats a patient for bleeding gastric ulcers and also takes a biopsy in a separate upper GI area. How should I code for these procedures?Louisiana Subscriber
Answer: In this case, you should report the biopsy with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple). Use 43255 (… with control of bleeding, any method) to report the ulcer treatment. Attach modifier 59 [...]

Reader Questions: Follow the 3-Year Rule   (June 2010)

Question: My gastroenterologist met with a patient in the office at the patient’s request (in other words, the service is not a consult). Although the gastroenterologist has seen the patient in the  past, the last visit occurred more than four years before. How should I code for this encounter?
Utah Subscriber
Answer: In this case, you should consider the patient new rather than established. Therefore, you would choose a code from the new patient outpatient services [...]

Reader Questions: Bill All Scopes if No Parent   (June 2010)

Question: The gastroenterologist performs a biopsy with sigmoidoscopy followed by an endoscopic removal of a foreign body. Which codes should I report for these procedures?
Montana Subscriber
Answer: In this case, neither scope is the base or parent procedure. Therefore, you would report both 45331 (Sigmoidoscopy, flexible; with biopsy, single or multiple) and 45332 (… with removal of foreign body).
Bottom line: If your gastroenterologist performs two scopes in the same family, neither of which is the base [...]

Reader Questions: ED Visit + Critical Care? Report Only 99291   (June 2010)

Question: A patient with abdominal pain presents to the ED, where the on-call gastroenterologist sees her. The patient undergoes an abdominal scan and laboratory tests, but when the patient begins vomiting blood, the gastroenterologist is called back to resume the care in the intensive care unit. The same on-call gastroenterologist then provides critical care for 35 minutes in total in the intensive care unit. How should I report this?
Texas Subscriber
Answer: In this case, you [...]

Reader Questions: Skip Code for Biopsy-Caused Bleeding   (June 2010)

Question: The gastroenterologist injected epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy (43239). How should I report this?
Hawaii Subscriber
Answer: The answer depends on what sort of bleeding your gastroenterologist treated. Go back to the procedure documentation and determine whether the ulcer was bleeding prior to the biopsy or if the biopsy caused the bleed. Then, choose from the following coding options based on the answer:
Option 1: If the ulcer was [...]

Reader Questions: Achalasia Requires Unique Code   (June 2010)

Question: My gastroenterologist used an esophageal dilation to treat achalasia (530.0) by breaking the lower esophageal sphincter muscle fibers with a balloon dilator larger than 30 mm in diameter. Which codes should I use to report this procedure?Oregon Subscriber
Answer: You should report 43458 (Dilation of esophagus with balloon [30 mm diameter or larger] for achalasia). Because there’s a definite risk of perforation with this procedure, your physician likely used an endoscope to visualize the esophagus [...]

Reader Questions: Get to the Bottom of Ascites Codes   (June 2010)

Question: A 52-year-old female presented with worsening abdominal distension and a 15-pound weight gain during the past month. She has a known history of ovarian cancer that was unsuccessfully resected a few months earlier. The increasing distension has made breathing difficult. The gastroenterologist reviewed the prior records and performed an abdominal sonogram, confirming the presence of ascites. He also decided to perform a large volume paracentesis (removal of abdominal fluid, 49080) to provide the patient [...]

Reader Questions: Review G-Tube Replacement Procedure Before Choosing 43760   (June 2010)

Question: The gastroenterologist treated a nursing home patient in the emergency department (ED) with a displaced G-tube and evidence of dehydration. She performed a detailed history and physical exam, ordered lab tests, and administered IV fluids for rehydration. Examination of the tube showed a significant clog. The gastroenterologist reviewed the lab tests, rehydrated the patient, and changed the G-tube. How should I report this encounter?
Arizona Subscriber
Answer: On the claim, you should: Report 43760 (Change of [...]

Quick Quiz: How Much Do You Know About Consultation Codes?   (June 2010)

Be aware of cms /cpt guideline differences to avoid denials.
When your gastroenterologist performs a colonoscopy, but is unable to completely visualize and inspect the entire colon, you’ll need to use modifier 52 (Reduced services) or 53 (Discontinued procedure). What makes your job challenging is that different payers have different rules. Use these tips to ensure you append the right modifier every time.
Distinguish Between Lesser and Incomplete Procedures
When your gastroenterologist documents that he performed a colonoscopy, [...]