Reader Question: Attempted EGD Means Attaching Modifier 53   (November 2011)

Question: The GI attempted an EGD on a patient with primary tongue carcinoma who had multiple therapies including radiation and surgery. The physician failed to advance the scope through the upper esophageal sphincter due to either a radiation stricture or an occlusion. How should I report this procedure?Maine SubscriberAnswer: Your case warrants the use of modifier 53 (Discontinued procedure). This modifier indicates that a surgical or diagnostic procedure was started but discontinued. Pay attention to [...]

Reader Question: Assisting Physician May Not Deserve 99360 After All   (November 2011)

Question: Our surgeons sometimes “standby” for other surgeons in some high-risk procedures or cases. They want to code for their time, and we want to use 99360. How should they document their time to be able to charge 99360?California SubscriberAnswer: CMS and many other payers don’t pay for 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]), so the [...]

Enema Administration: Case Analysis: Skip Radiology Codes For Rectal Drug Supervision   (October 2011)

ICD-9 564.0x should describe constipation, but don’t forget to report comorbid conditions, too.Not all enemas are imaging procedures. Sometimes the gastroenterologist will opt to administer an enema to treat constipation. Your challenge in such cases is whether to include the enema tubing in an E/M or bill it as a separate procedure. Use the following situation – plus the bonus tips – to help you with accurate coding.Scenario: Our nursing staff administered an enema for an elderly [...]

Esophagogastroduodenoscopy: Hold Off Reporting 43255 Unless For Hemostasis   (October 2011)

A potential $280 reimbursement could slip through your fingers if you fail to report control-of-bleeding correctly.When your gastroenterologist performs EGD to control upper gastrointestinal bleeding, you might not look beyond a sole CPT® code to report the procedure.Here’s a case straight from a physician’s operative report to illustrate:Procedure: Esophagogastroduodenoscopy with submucosal injection of epinephrine and bipolar cauterization. Indication for the procedure: Upper GI bleeding. Please see full dictated note dated September 15, 2011. Medication: General [...]

ICD-10: Same-Function Codes For Constipation Extend To ICD-10   (October 2011)

New code K59.0 will feature four more subclassifications.Constipation (564.0) refers to the condition in which bowel movements are infrequent or incomplete. When a patient suffers from constipation, he usually experiences a decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool.ICD-10 difference: When ICD-9-CM shifts to ICD-10-CM in Oct. 1, 2013, code 564.0 will become K59.0 (Constipation). You will treat your ICD-10 claims for [...]

Evaluation and Management: Adhere To Specific Rules Before Reporting Telephone Care   (October 2011)

Phone consults could earn you as much as $25.48 from payers, except Medicare.Physicians and their patients spend more and more time on the phone for consultations these days, but is this service a no-no? If you’re asking whether or not you can make money out of this service, the answer is yes. Then again, just like other consultation codes, you have to stick to some guidelines.Downside: Medicare will not pay for patient consultations performed over [...]

You Be the Coder: Watch Out For External , Endoscopic PDT Disparity   (October 2011)

Question: My colleague thinks we should report 96567 for an hour’s photodynamic therapy (PDT) session on a patient with Barrett’s esophagus. I don’t think 96567 is the correct CPT. What advice can you give?Texas SubscriberAnswer: You’re right, 96567 (Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa [e.g., lip] by activation of photosensitive drug[s], each phototherapy exposure session) is not the correct PDT code. Just [...]

Reader Question: Let 45330 Prove Its Worth By Itself   (October 2011)

Question: My gastroenterologist performed a flexible sigmoidoscopy in a facility setting and found a 30 cm fistula. The fistula was filled with fibrin. The physician attempted closure with clips, but they malfunctioned. He, then, used a band ligator. On the third try, he was able to get enough tissue to entrap and hold the ligator. Should I append modifier 22 to 45330 and ask for additional payment?Hawaii SubscriberAnswer: If you add modifier 22 (Increased procedural [...]

Reader Question: CPT^® 17110 Definition Contains Plasma Ablation, Too   (October 2011)

Question: Our gastroenterologist treats a patient who has a gastrostomy tube. The op note indicates that the patient has “some issues with granulation tissue at the stomal site that gets irritated and bleeds.” The physician performed “argon plasma photoablation of granulation tissue at stomal site.” Can I use 17110 even though its descriptor says nothing about plasma ablation?Oklahoma SubscriberAnswer: Yes. You should use 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign [...]

Reader Question: Don’t Overlook 3-Card Rule for 82270   (October 2011)

Question: How should I know when to code for a screening fecal occult blood test (FOBT)?California SubscriberAnswer: Take note of the ordering diagnosis, and you’ll know whether to use a diagnostic or screening code for FOBT. If the physician reports V76.51 (Special screening for malignant neoplasms; colon) or V76.41 (Special screening for malignant neoplasms; rectum), it means the lab is performing a screening.If the physician orders the FOBT based on a known condition, disease sign [...]