http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Gastroenterology Coding - Recent Topics en Sun, 12 Feb 2012 13:15:23 +0000 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/ <p>I have coded the below OP report as follows:<br /> Dx 574.51, 574.21 CPT 43264, 43262, 43271, 43235 -59, 43273, 74360<br /> 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?</p> <p>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. </p> 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/ <p>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:</p> <p>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. </p> 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/ <p>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? </p> 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/ <p>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. </p> <p>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. </p> <p>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)<br /> Please clarify this to me. </p> 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/ <p>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. </p> <p>Any thoughts, please. </p> 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/ <p>Patient had laproscopic low anterior colon resection <code>44207</code> and then intraoperative colonoscopy <code>45378</code> Is intraoperative colonoscopy billable? </p> 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/ <p>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. </p> 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/ <p>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. </p> <p>I wonder if <code>43258</code> would be appropriate with 22 since doctor put 3 more clips. or <code>43236</code> with 22. </p> <p>Thank you</p> <p>Julie Agus </p> 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/ <p>cos with tattooing? </p> 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/ <p>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? </p> 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/ <p>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?</p> <p>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? </p> 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/ <p>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. </p> 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/ <p>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.<br /> If procedure is done in duodenum, either code seems to cover that area. What other detail would support the code choice?<br /> thank you. </p> 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/ <p>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?</p> <p>Thank you<br /> Steph </p> http://www.supercoder.com/forum/topic/44366-with-43235-59#post-10717 Sat, 21 Jan 2012 00:23:17 +0000 maarit 10717@http://www.supercoder.com/forum/ <p>My question is: if enteroscopy is done into 3rd segment of duodenum, but he is also looking for GI bleed on the way down in the upper sections, could I justify billing for 44366 and 43235 -59 both? Coding tips say “report the appropriate endoscopy for each anatomic site examined”, but is this a stretch?</p> <p>In the OP note: standard scope buckled in the stomach and was exchanged to pediatric colonoscope which was advanced to 3rd segment. a bleed in the 3rd section of duodenum is stopped by a gold probe and two clips. </p> http://www.supercoder.com/forum/topic/59-modifier-on-which-procedure#post-10682 Thu, 19 Jan 2012 21:23:04 +0000 Kimberly Tews 10682@http://www.supercoder.com/forum/ <p>What determines which procedure the 59 modifier is placed with? In this particular case, 45330 and 46930 performed at same sitting. Which would get the 59 modifier? </p> http://www.supercoder.com/forum/topic/correct-use-of-modifiers-33-and-pt#post-10405 Thu, 12 Jan 2012 17:11:08 +0000 Mary Lou Thompson 10405@http://www.supercoder.com/forum/ <p>when screening colonoscopy becomes surg/diag for medicare pts what is the correct way to use the -PT modifier? same senario for non-medicare pts what is correct way to use -33 mod? is screening dx code primary with polyp etc code secondary? i am getting mixed info from other coders on this issue. </p> http://www.supercoder.com/forum/topic/for-procedure-44140-with-modifier-82#post-10542 Mon, 16 Jan 2012 21:09:16 +0000 Kinyi Haber 10542@http://www.supercoder.com/forum/ <p>Can the assistant surgeon bill the same amount billed by the principal surgeon? </p> http://www.supercoder.com/forum/topic/office-surgery#post-10427 Thu, 12 Jan 2012 20:23:43 +0000 Try Super 10427@http://www.supercoder.com/forum/ <p>How can surgeon get additional payment for facility and equipment if surgery was done in office? </p> http://www.supercoder.com/forum/topic/lower-device-assisted-enteroscopy-retrograde#post-10259 Mon, 09 Jan 2012 21:03:55 +0000 jeana abbey 10259@http://www.supercoder.com/forum/ <p>How would this be coded? </p> http://www.supercoder.com/forum/topic/99203-with-v7651#post-8920 Fri, 18 Nov 2011 19:59:03 +0000 Myra Coronado 8920@http://www.supercoder.com/forum/ <p>why do i keep on getting deniels when i bill a 99203 with a v76.51? Can anyone help me please </p> http://www.supercoder.com/forum/topic/remicade-infusion-with-blood-specimens-drawn#post-10235 Mon, 09 Jan 2012 15:33:41 +0000 Susan Smith 10235@http://www.supercoder.com/forum/ <p>OUR REMICADE NURSE WILL DRAW BLOOD FOR LABS THROUGH THE LINE THAT IS ALREADY IN PLACE FOR THE INFUSION.CAN WE CHARGE 36592(COLLECTION OF BLOOD SPECIMEN USING AN ESTABLISHED CENTRAL OR VENOUS LINE)FOR THE<br /> SPECIMEN? </p> http://www.supercoder.com/forum/topic/esophageal-impedance-with-ph-monitoring#post-10149 Thu, 05 Jan 2012 17:41:24 +0000 Tanya Ocampo 10149@http://www.supercoder.com/forum/ <p>2011 GI Survival Guide suggests to code an esophageal impedance with pH monitoring as stated below:</p> <p>In this case, you should report one unit of 91038 along with 91034.</p> <p>According to the CCI edit, these two codes can NEVER be coded together. Please correct or clairify...<br /> Thanks! </p> http://www.supercoder.com/forum/topic/is-43231-included-in-ercp#post-10148 Thu, 05 Jan 2012 17:26:18 +0000 maarit 10148@http://www.supercoder.com/forum/ <p>Side viewing duodenoscope was passed through the mouth into the duodenum. Attempt to cannulate the common bile duct failed after multiple attempts.<br /> Dr wants to bill for 43260 and 43231. is this correct? Also, should I use mod. 53 since the attempt was failed?<br /> thank you for your help. </p> http://www.supercoder.com/forum/topic/h2-pylori-breath-tests-denials-by-medicare#post-10033 Tue, 03 Jan 2012 16:47:24 +0000 Sarah Kneefel 10033@http://www.supercoder.com/forum/ <p>'91065' - We started receiving denials by Medicare in October for this code. We perform breath tests to check for bacteria in the intestines. The NCD states that 91065 is only covered for lactose malabsorption. I have not been able to find an LCD for our region (CO). Do you have any information on dx that we could use to get paid for this procedure? </p> http://www.supercoder.com/forum/topic/is-4550-internal-hemorrhoids-payble-dx-for-colonoscopy-45378#post-10003 Fri, 30 Dec 2011 20:08:28 +0000 GERALDINE LUSKER 10003@http://www.supercoder.com/forum/ <p>for PPO ins like uhc or bx</p> <p>is 455.0 payable dx for colonscopy or are there other diagnosis<br /> required? </p> http://www.supercoder.com/forum/topic/endoscopic-ultrasound-with-celiac-plexus-nerve-block-for-pain#post-9948 Thu, 29 Dec 2011 15:34:50 +0000 Lori Salmon 9948@http://www.supercoder.com/forum/ <p>How do you code for endoscopic ultrasound with celiac plexus nerve block for pain. Patient is a 60 y/o with pancreatic cancer. 20 cc of 0.25% bupivacaine was injected into the celiac artery. Following this 20 cc of 98% ethanol was injected. </p> http://www.supercoder.com/forum/topic/how-will-you-code-a-2-mm-polyp-in-sigmoid-colon-removed-by-forceps-is-45380#post-9896 Tue, 27 Dec 2011 16:52:28 +0000 Marva Brown 9896@http://www.supercoder.com/forum/ <p>(45380) </p> http://www.supercoder.com/forum/topic/what-cpt-and-icd-9-proc-codes-should-be-used-to-bill-for-halo-ablation-procedure#post-9841 Thu, 22 Dec 2011 18:02:31 +0000 voilet l vinson 9841@http://www.supercoder.com/forum/ <p>what cpt and icd-9 proc codes should be used to bill for halo ablation procedure done in the GE/GI lab at a hospital? </p> http://www.supercoder.com/forum/topic/multiple-polyp-removals-during-one-encounter#post-9457 Sat, 10 Dec 2011 03:25:27 +0000 Catherine Du Toit 9457@http://www.supercoder.com/forum/ <p>Do youfollow the common rule of different techniques in different areas of colon when billing for facility? E.g. 45385 in ascending colon and 45380 in transverse. Otr would you bill for 45385 and 45380 performed in descending. </p>