Supercoder - Ask an Expert? Forum: Gastroenterology Coding

Supercoder - Ask an Expert? Forum: Gastroenterology Coding - Recent Posts http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Gastroenterology Coding - Recent Posts en Sun, 12 Feb 2012 12:39:59 +0000 maarit on "Endoclip placement on a tear during ERCP?" http://www.supercoder.com/forum/topic/endoclip-placement-on-a-tear-during-ercp#post-11343 Fri, 10 Feb 2012 21:24:13 +0000 maarit 11343@http://www.supercoder.com/forum/ I have coded the below OP report as follows: Dx 574.51, 574.21 CPT 43264, 43262, 43271, 43235 -59, 43273, 74360 I'm unsure if the documentation supports EGD and the fluoro. Also, how would you code the placement of an endoclip on a tear...or would this be bundled? The side-viewing duodenoscope was passed through the mouth and advanced with ease to the 2nd portion of the duodenum. The visualized esophageal and gastric mucosa are normal. The ampulla appears a bit prominent but has no evidence of recent stone passage. Cannulation of bile duct was achieved on first attempt with wire guide. Common bile duct was filled with contrast.numerous filling defects. Because of the numerous stones, a sphincterotomy was followed by 8 mm CRE balloon dilatation of the cut and then a 12 and 18 mm stone extraction balloons were used to extract the stones. There was a 4 mm long mucosal tear above the roof of the sphincterotomy and there an endoclip was placed to close it down. After clip was placed the bile duct was cannulated again and non-occlusion by the clip was verified. Fluoroscopy interpretation during procedure by myself. maarit on "CPT 43264" http://www.supercoder.com/forum/topic/cpt-43264#post-11307 Thu, 09 Feb 2012 21:30:41 +0000 maarit 11307@http://www.supercoder.com/forum/ I need help with this claim. Stones were seen in gallbladder during ultrasound, but during ERCP only blood clots were removed. How do you code the above procedure? Sanjit Mishra on "Colonoscopy w/bougie dilation & biopsy" http://www.supercoder.com/forum/topic/colonoscopy-wbougie-dilation-biopsy#post-11298 Thu, 09 Feb 2012 19:21:06 +0000 Sanjit Mishra 11298@http://www.supercoder.com/forum/ 45380. No CPT code describes dilation of the colon. Therefore, you should use an unlisted-procedure code. Report 44799 (Unlisted procedure, intestine). Sherry Olson on "Colonoscopy w/bougie dilation & biopsy" http://www.supercoder.com/forum/topic/colonoscopy-wbougie-dilation-biopsy#post-11263 Wed, 08 Feb 2012 18:05:30 +0000 Sherry Olson 11263@http://www.supercoder.com/forum/ How would you code this? My doctor did a complete colonoscopy and then pulled the colonoscope back into the rectum. Then he used a 42 French Maloney dilator, passed rectally and dilated the narrowing of the colonic lumen. A rectosigmoid biopsy was also obtained. Per CCI edits 45303 bundles into 45380. Is there another code that more reflects all procedures? Sanjit Mishra on "V76.51 and 99203" http://www.supercoder.com/forum/topic/v7651-and-99203#post-11225 Tue, 07 Feb 2012 15:44:34 +0000 Sanjit Mishra 11225@http://www.supercoder.com/forum/ In the link above it is written that, "....code 99213 would require modifier 33 when the provider indicates that the service was preventive...." This seems to suffice that for BCBS, you can also use modifier 33 with new pt visit 99203 if the the service is found to be preventive. maarit on "V76.51 and 99203" http://www.supercoder.com/forum/topic/v7651-and-99203#post-11218 Mon, 06 Feb 2012 21:46:48 +0000 maarit 11218@http://www.supercoder.com/forum/ I'm sorry. I do not have access to that article. Is there a simple answer? Sanjit Mishra on "Diagnosis Order for Previous Polyp Removal" http://www.supercoder.com/forum/topic/diagnosis-order-for-previous-polyp-removal#post-11213 Mon, 06 Feb 2012 20:03:33 +0000 Sanjit Mishra 11213@http://www.supercoder.com/forum/ In a follow-up colonoscopy visit, if the further colonoscopy exam gives findings of colonic polyp, then the Dx codes would be 211.3, and additionally you can code V12.72, and V67.09 Randa Cain on "Diagnosis Order for Previous Polyp Removal" http://www.supercoder.com/forum/topic/diagnosis-order-for-previous-polyp-removal#post-11199 Mon, 06 Feb 2012 16:05:11 +0000 Randa Cain 11199@http://www.supercoder.com/forum/ Patient previously had colonic polpys removed and is returning now for follow up colonoscopy and the doctor finds and removes more polyps. I have been billing the diagnosis as follows: V67.09, V12.72, 211.3. I was just told by a hosipital coder that according to their guidelinese that is not correct and would be "dinged" in an audit because I should have only billed 211.3 for the new findings. The V codes are only to be used if they do not find and remove new polpys. Any thoughts, please. Sanjit Mishra on "Can we code `45378` with `44207` during surgery or is `45378` bundled in ?" http://www.supercoder.com/forum/topic/can-we-code-45378-with-44207-during-surgery-or-is-45378-bundled-in#post-11176 Sat, 04 Feb 2012 02:49:19 +0000 Sanjit Mishra 11176@http://www.supercoder.com/forum/ It should be considered part of the other surgery performed here, and not billable. Sanjit Mishra on "V76.51 and 99203" http://www.supercoder.com/forum/topic/v7651-and-99203#post-11175 Sat, 04 Feb 2012 02:45:18 +0000 Sanjit Mishra 11175@http://www.supercoder.com/forum/ You are right in pointing out this. So, the relevant article is here: <a href="http://www.supercoder.com/articles/articles-alerts/mob/cpt-2012-primer-rejoice-the-addition-of-a-new-flu-vaccine-code-new-preventive-services-modifier-108836/" rel="nofollow">http://www.supercoder.com/articles/articles-alerts/mob/cpt-2012-primer-rejoice-the-addition-of-a-new-flu-vaccine-code-new-preventive-services-modifier-108836/</a> Nikki Taylor on "Humira Injection" http://www.supercoder.com/forum/topic/humira-injection#post-11168 Fri, 03 Feb 2012 21:08:12 +0000 Nikki Taylor 11168@http://www.supercoder.com/forum/ What CPT code do I need to bill for a Humira injection? The patient brought in a sample and the nurse administered the drug. Should we use the 96372 or the 96401 code? I'm leaning more towards the 96372 because we are using the drug for a patient with Chron's disease. maarit on "V76.51 and 99203" http://www.supercoder.com/forum/topic/v7651-and-99203#post-11166 Fri, 03 Feb 2012 20:34:46 +0000 maarit 11166@http://www.supercoder.com/forum/ My question still remains: should we bill for the initial consult of a screening colonoscopy as 99203 -33 and 99203 -pt depending on carrier. Your examples (below) did not include this scenario. Modifier 33 “Delineated Preventive Service” is used to indicate that a specific preventive service should be a payable service and not another type of preventive service that is typically not paid by insurers. Types of services that might have a modifier 33 include the following: *** •For Medicare IPPE (welcome to Medicare), initial and subsequent wellness encounters •Well woman exam (screening breast and pelvic exam for Medicare) •Well baby or well child encounters •Annual physical exam for some commercial payers and Medicaid *** Types of preventive services that would not have this modifier include the following: •Travel physical •Sports exam •School physical •Employment exam Sanjit Mishra on "V76.51 and 99203" http://www.supercoder.com/forum/topic/v7651-and-99203#post-11158 Fri, 03 Feb 2012 17:48:14 +0000 Sanjit Mishra 11158@http://www.supercoder.com/forum/ That was not mentioned in your earlier posts that the patient came for Screening purpose. I am submitting the complete guidelines relating to this: ************************************ Centers for Medicare & Medicaid Services to clarify billing instructions for the Medicare beneficiary who 1) presents for a screening colonoscopy (or flexible sigmoidoscopy), 2) has no gastrointestinal symptoms, and 3) during their screening colonoscopy (or flexible sigmoidoscopy), have an abnormality identified (such as a polyp, etc.) which is biopsied or removed. If a polyp is found, the above scenario should be billed as follows: Primary Dx: V76.51 (Special screening for malignant neoplasms, Colon) Secondary Dx: 211.3 (Benign neoplasm of other parts of digestive system, Colon). ================================================================================ Therapeutic colonoscopy *********************** When signs and symptoms are related to the GI tract (i.e., abdominal pain, blood in stool, chronic diarrhea, change in bowel habits, weight loss or blood loss anemia), the above mentioned V-code (V76.51) should never be assigned. A symptom code should be assigned when there is no definitive diagnosis. If the patient's history notes a family history or personal history of colonic malignancy or polyps, the appropriate V-code from the box above should be assigned as a secondary code. * CPT codes 45380-45385 are used to report procedures through the colonoscope. Therapeutic colonoscopies include a diagnostic component; code 45378 is not reported with the services below. * When the above procedures are performed for a Medicare patient who originated as a screening colonoscopy, the HCPCS G-code should not be reported. CPT 45378 should not be reported with 45308-45385. * Modifiers -33 and -PT :Assign modifier- 33 to non-Medicare therapeutic procedures and modifier -PT to Medicare therapeutic procedures. ============================================== Modifier 33 “Delineated Preventive Service” is used to indicate that a specific preventive service should be a payable service and not another type of preventive service that is typically not paid by insurers. Types of services that might have a modifier 33 include the following: *** •For Medicare IPPE (welcome to Medicare), initial and subsequent wellness encounters •Well woman exam (screening breast and pelvic exam for Medicare) •Well baby or well child encounters •Annual physical exam for some commercial payers and Medicaid *** Types of preventive services that would not have this modifier include the following: •Travel physical •Sports exam •School physical •Employment exam maarit on "V76.51 and 99203" http://www.supercoder.com/forum/topic/v7651-and-99203#post-11156 Fri, 03 Feb 2012 17:28:10 +0000 maarit 11156@http://www.supercoder.com/forum/ May we bill for the initial consult for a PT who comes for a screening colonoscopy without any symptoms? There seems to be a lot of confusion about this. According to BCBS bulletin in April the new modifiers 99203 -33 for comercial ins, and 99203 -PT for Medicare are to be used for this initial preventive visit. However, some other sources say these modifiers are to be used on the colonoscopy CPT when the screening procedure turns into diagnostic (45378 turns into 45380 or 45385) Please clarify this to me. Kim Nelson on "Can we code `45378` with `44207` during surgery or is `45378` bundled in ?" http://www.supercoder.com/forum/topic/can-we-code-45378-with-44207-during-surgery-or-is-45378-bundled-in#post-11137 Thu, 02 Feb 2012 21:28:59 +0000 Kim Nelson 11137@http://www.supercoder.com/forum/ Patient had laproscopic low anterior colon resection <code>44207</code> and then intraoperative colonoscopy <code>45378</code> Is intraoperative colonoscopy billable? suzanne cassimore on "EGD with APC for gastrocutaneous fistula" http://www.supercoder.com/forum/topic/egd-with-apc-for-gastrocutaneous-fistula#post-11108 Thu, 02 Feb 2012 15:07:45 +0000 suzanne cassimore 11108@http://www.supercoder.com/forum/ Patient has previous gastrojejunostomy surgery. Now is back for having gastrocutaneous fistula. Doctor performed EGD with APC to the site of the fistula and applied 3 clips. What code is best to use. I wonder if <code>43258</code> would be appropriate with 22 since doctor put 3 more clips. or <code>43236</code> with 22. Thank you Julie Agus Sanjit Mishra on "How would i bill for a cos with tattooing and metallic clips placed?" http://www.supercoder.com/forum/topic/how-would-i-bill-for-a-cos-with-tattooing-and-metallic-clips-placed#post-11107 Thu, 02 Feb 2012 14:27:12 +0000 Sanjit Mishra 11107@http://www.supercoder.com/forum/ Please submit more relevant details. maarit on "CPT 43264" http://www.supercoder.com/forum/topic/cpt-43264#post-11096 Wed, 01 Feb 2012 20:41:34 +0000 maarit 11096@http://www.supercoder.com/forum/ Is it correct to bill for 43264 if the procedure was done, but the surgeon was not sure if the stones came out? Should I wait for pathology? and if no stones or sludge was found, remove 43264? Please see below: A sphincterotomy was done and balloon sweeps retrieved two large clots, dirty bile with white flecks and some old blood, there could have been a stone enveloped in a clot but it was not clearly apparent. ALICIA LEDEZMA on "How would i bill for a cos with tattooing and metallic clips placed?" http://www.supercoder.com/forum/topic/how-would-i-bill-for-a-cos-with-tattooing-and-metallic-clips-placed#post-11075 Wed, 01 Feb 2012 00:49:42 +0000 ALICIA LEDEZMA 11075@http://www.supercoder.com/forum/ cos with tattooing? Sanjit Mishra on "anorectal manometry" http://www.supercoder.com/forum/topic/anorectal-manometry#post-11020 Mon, 30 Jan 2012 21:38:17 +0000 Sanjit Mishra 11020@http://www.supercoder.com/forum/ May 2009:- <a href="http://www.trailblazerhealth.com/Publications/Newsletter%20-%20eBulletin/TrailBlazerBulletinMay2009.pdf" rel="nofollow">http://www.trailblazerhealth.com/Publications/Newsletter%20-%20eBulletin/TrailBlazerBulletinMay2009.pdf</a> * Yes, you are right, and since Trailblazer is the Medicare carrier for your area, you have to follow Trailblazer Guidelines. I don't have Trailblazer update of it, but you can contact Trailblazer Insurance rep to confirm this. Eileen Mullen on "anorectal manometry" http://www.supercoder.com/forum/topic/anorectal-manometry#post-11009 Mon, 30 Jan 2012 19:01:10 +0000 Eileen Mullen 11009@http://www.supercoder.com/forum/ Trailblazer is the Medicare carrier for our area. The RN performed anorectal manometry (91122). The previous information from Trailblazer was that the MD had to perform the procedure. Has this changed? Sanjit Mishra on "Screening colonoscopy" http://www.supercoder.com/forum/topic/screening-colonoscopy#post-10966 Sat, 28 Jan 2012 21:29:16 +0000 Sanjit Mishra 10966@http://www.supercoder.com/forum/ Specific Answer: The type of visit associated with a patient's past history of colonic polyps, but has scheduled a visit without any symptom with an office/outpatient visit to discuss with the physician for scheduling a screening colonoscopy to rule out malignancy. The physician, evaluates the context of past history of the patient, keeping in view of the patient's age and other family history and decides on the scheduling of colonoscopy. Then you can use Primary Dx as V76.51 and Secondary Dx as V12.72. * * OTHER COLONOSCOPY CODING SCENARIOS ---------------------------------- First, you need to assess the patient's level of risk. Was the patient average risk and the coder simply put the common finding of colonic polyps (211.3) as the primary diagnosis? If so, simply correct the claim to show V76.51 as the primary diagnosis and 211.3 as the secondary diagnosis, and re-file to the insurance company as a corrected claim along with a copy of the colonoscopy report to show the patient was in fact here for colorectal cancer screening, and diverticulosis was an incidental finding. The same process can be followed if a colon polyp is removed. Simply use V76.51 as the primary diagnosis and the colon polyp as the incidental finding, secondary diagnosis. * Second, you need to assess the tools used and if there are polyps or other abnormalities found during screening colonoscopy. The type of intervention performed during the examination determines the procedure code. If a colon polyp or abnormality is encountered, there are many different removal techniques that can take place. For example, snare polypectomy (45385), hot biopsy forceps polypectomy (45384), or argon beam plasma coagulation fulguration (45383) or cold biopsy forceps (45380) can all be performed for colon or rectal polyp removal. Also, each of these procedure codes is reported only once regardless of the number of polyps removed. * Third, you need to assess the actual medical necessity behind performing the colonoscopy in the first place. It would not be medically necessary for an asymptomatic average risk patient (V76.51) to be screened at a two, three or five-year interval. However, it might be medically necessary for an asymptomatic high-risk patient (V12.72, V16.0, etc.) to be screened every two, three or five years, therefore the diagnosis code used should reflect that. * Modifiers used in coding for colonoscopy have not changed; however, there are two new modifiers that directly impact this procedure. Effective Jan. 1, 2011, modifier -PT is to be used for fee-for service Medicare claims only, to show that an intervention was performed during the otherwise screening colonoscopy. By appending modifier -PT to the CPT code, this tells Medicare to waive the deductible for the patient for this procedure. Modifier -33 (preventive service) is attached to the CPT code to notify to commercial insurance companies that the colonoscopy started as a screening, but ended up diagnostic. Modifier -33 is new for 2011 and is not published in most CPT books, as it was approved for use by the American Medical Association after the 2011 books were printed. Check with your local carriers for specific use or requirements before using modifier -33. Betsy Beatty on "Screening colonoscopy" http://www.supercoder.com/forum/topic/screening-colonoscopy#post-10964 Sat, 28 Jan 2012 19:58:30 +0000 Betsy Beatty 10964@http://www.supercoder.com/forum/ Can someone please give me guidance on when we can bill screening codes and when we cannot. For instance, if a patient previously had polyps but now is having no signs or symptoms, can we bill a screening and use V12.72 as the secondary dx code? If a patient had a partial colectomy due to cancer, but now is having no signs and symptoms, can we use a screening dx with a hx of colon ca as secondary dx? Sanjit Mishra on "chemodenervation" http://www.supercoder.com/forum/topic/chemodenervation#post-10953 Fri, 27 Jan 2012 19:46:15 +0000 Sanjit Mishra 10953@http://www.supercoder.com/forum/ I agree that the coverage differs from Insurance to Insurance. Example: Medicaid covers an administration fee when billed with the injection (J0585 or J0587) on the same day of service with the J0585 or J0587 code. Note: An administration fee is not covered on the same day of service as an evaluation and management code for recipients age 21 and over. Medicaid recipients aged 21 and older may be subject to co-payments for office visits. Cathy Tehee on "chemodenervation" http://www.supercoder.com/forum/topic/chemodenervation#post-10942 Fri, 27 Jan 2012 17:20:51 +0000 Cathy Tehee 10942@http://www.supercoder.com/forum/ cpt code <code>46505</code> is the botox used for this procedure billable seperately to other insurance carriers? I know that Medicare would consider it inclusive to the procedure. Sanjit Mishra on "43255 versus 44366" http://www.supercoder.com/forum/topic/43255-versus-44366#post-10906 Thu, 26 Jan 2012 21:58:19 +0000 Sanjit Mishra 10906@http://www.supercoder.com/forum/ You are right that there is a portion common to both, can be cause of confusion. But, I think the key is the past medical history or past op notes and present documentation and indication that will support what codes to be applicable. * * Although the parts you mentioned are common in both, but there is difference in documentation. The UGI endoscope(43255) includes a detailed documentation of observation be it positive or negative(abnormal or normal)of esophagus, stomach, and also of duodenum. Endoscopic Base Code : 43235 * But, the indication for 44366 are either based on findings on previous radiological exams, or present indication that directly relates to Duodenum and the documentation doesn't focus on findings of region of esophagus, stomach. Indications are not related to stomach and esophagus too. Endoscopic Base Code : 44360 Sanjit Mishra on "LIFT SPROCEDURE FOR COLORECTAL" http://www.supercoder.com/forum/topic/lift-sprocedure-for-colorectal#post-10885 Thu, 26 Jan 2012 16:56:38 +0000 Sanjit Mishra 10885@http://www.supercoder.com/forum/ The LIFT procedure (ligation of intersphincteric fistula) would be assigned CPT code 46275, "Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric." maarit on "43255 versus 44366" http://www.supercoder.com/forum/topic/43255-versus-44366#post-10867 Thu, 26 Jan 2012 00:58:47 +0000 maarit 10867@http://www.supercoder.com/forum/ Could someone please help me understand the difference between 44366 and 43255? See the question above. STEPHANIE MADISON on "LIFT SPROCEDURE FOR COLORECTAL" http://www.supercoder.com/forum/topic/lift-sprocedure-for-colorectal#post-10856 Wed, 25 Jan 2012 21:32:44 +0000 STEPHANIE MADISON 10856@http://www.supercoder.com/forum/ I am looking the correct code to use for a ligation of an intersphincter fistula. I haven't had much luck, can anyone help me out with this? Thank you Steph maarit on "43255 versus 44366" http://www.supercoder.com/forum/topic/43255-versus-44366#post-10758 Mon, 23 Jan 2012 20:31:10 +0000 maarit 10758@http://www.supercoder.com/forum/ If the bleeding is controlled in the duodenum, do you choose the CPT by the instrument used: upper EGD scope versus pediatric colonoscope? How far does the exam need to reach in order to qualify for 44366? CPT states:44366= beyond second part of duodenum, not including ileum/ and 43255 = duodenum or jejunum. If procedure is done in duodenum, either code seems to cover that area. What other detail would support the code choice? thank you.