Reader Question: Antral Erythema Translates To 535.4 In ICD-9   (October 2011)

Question: What is the diagnosis code for antral erythema?Washington, D.C. SubscriberAnswer: If your gastroenterologist hasn’t diagnosed anything more specific, use 535.4 (Other specified gastritis). You would use this code when your physician refers to redness in the bottom of the stomach, probably caused by gastritis and possibly indicating an ulcer.

Reader Question: Non-Bleeding Varices Treatment: Reserve 43244 For Band Ligation Method   (October 2011)

Question: How do you bill for the gastro banding procedure code 43244? Illinois SubscriberAnswer: CPT 43244 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices) is just one of several codes you could use to report treatment of esophageal and/or gastric varices. Others include 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of [...]

Reader Question: Bill A Non Completed Exchange Based On Time Spent   (October 2011)

Question: We scheduled a patient for a PEG exchange in the office. His tube had come out and a foley had been inserted. We attempted to place the new G tube but could not. The physician replaced the foley, and scheduled the patient for an EGD with PEG placement the next day at the hospital. Can we bill 43760 with modifier 53, or can we only bill for an office visit? Obviously, we cannot re-use [...]

Reader Question: Assert Provider’s Entitlement For 43235, 91110 Reimbursement   (October 2011)

Question: Our physician places a capsule that we bought through our private practice and he brought over to the surgical center to place via endoscopy. We billed 43235 and 91110-52, and were paid. Later on, however, the insurance company notified us that they were taking back half of our payment on the 91110 stating we should have billed with modifier 26 as the hospital is billing for the same procedure code (91110). I think since [...]

Diagnosis Coding: Coding Nondefinitive Diagnoses Remain Your Biggest Challenge   (September 2011)

All you need to report are signs and symptoms when diagnostics come back normal.You think you may have mastered most ICD-9 challenges, but do you know how to deal with a diagnostic test that comes back sans a definitive diagnosis? When you make sure to convey to payers exactly what you found, you’ll overcome these challenges. Here are sure-fire ways how to do that.Follow 3 Rules for Normal Diagnostics ResultsScenario 1: The gastroenterologist refers a [...]

ICD-10: Get Ready To Use K Code For Intra-abdominal Abscess In 2013   (September 2011)

Get Ready To Use K Code For Intra-abdominal Abscess In 2013Intra-abdominal abscess refers to a pocket of infected fluid and pus located inside the abdominal cavity. This condition is usually caused by a ruptured appendix, ruptured intestinal diverticulum, inflammatory bowel disease, and parasite infection in the intestines.A CT scan of the abdomen will usually uncover an intra-abdominal abscess. A needle placed through the skin into the abscess cavity will confirm the condition. When a physician [...]

Esophagogastroduodenoscopy: Details In The Op Note And Documentation Will Spell The Difference When Coding EGD.   (September 2011)

Describe a different site biopsy by attaching modifier 59.If you think you know your way around esophagogastroduodenoscopy coding, get back over it. EGD can be a tricky issue for many medical coders. If you look up the CPT 2011 manual for the word “esophagogastroduodenoscopies,” it will point you to “see endoscopy, gastrointestinal, upper,” and you’ll end up with diagnostic/screening processes or results codes 3130F-3132F, 3140F-3141F. But that’s not always the case.Your operative notes can tell [...]

Modifiers: Spot The Difference Between Modifiers 51, 59   (September 2011)

Medicare prefers you don’t use one of these modifiers at all. Find out which one.Many coders often find themselves in a tight spot when coding repairs of wounds on different anatomical sites. Whether the second code should take a modifier 51 or 59 consumes a huge part of their dilemma. CPT states that the second code would take a modifier 51 if the classifications are different, but what about if the anatomic groups are different?Don’t [...]

You Be the Coder: Hot Biopsy Technique Leads You To 45384   (September 2011)

Question: Our GI saw a patient for endoscopic biopsy. The patient’s mucosa was normal except for internal hemorrhoids and a raised sessile diminutive polyp in the sigmoid colon that was ablated through hot biopsy forceps. What CPT describes this procedure?New Jersey SubscriberAnswer:  In general, the technique (cold biopsy forceps, hot biopsy forceps, or snare technique) should drive your code selection. However it is possible to ablate a polyp or lesion not amenable to removal with [...]

Reader Question: Fill In Two Of Three E/M Components For Follow-Up Visits   (September 2011)

Question: I am auditing some of my gastroenterologist’s E/M visits, and discovered that he’s not dictating a “physical exam” on the patient. He gives reason for the visit (i.e., vitals, past history, assessment and plan), but no physician exam notes on any follow-up patient. I’m pretty sure we need some type of documented physical exam (e.g., general mental status, general appearance, and orientation). When I discussed it with him, he says documented physical exam not [...]