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43255 or 44378/44370

Eleen Posted Thu 29th of November, 2012 16:23:10 PM

Upper Device-Assisted Enteroscopy without fluoroscopy
Indications: Anemia, Melena
After obtaining informed consent, the endoscope was passed under direct vision using the device-assisted technique. Throughout the procedure, the patient's blood pressure, pulse, and oxygen
saturations were monitored continuously. The Enteroscope was introduced through the mouth, and advanced to the jejunum. The upper GI endoscopy was accomplished without difficulty. After obtaining
informed consent, the endoscope was passed under direct vision using the device-assisted technique.Throughout the procedure, the patient's blood pressure, pulse, and oxygen saturations were monitored
continuously.Procedure:The examined esophagus was normal.
Findings:In the body of the stomach, a single actively bleeding visible vessel was seen immediately adjacent to a previously placed
clip. Initial attempts to achieve hemostasis through injection of epinephrine and electrocautery using a 7Fr gold probe were
unsuccessful. Hemostasis was then achieved by placing a single Ovesco over the scope clip on the vessel. The exam of the stomach was otherwise normal.The examined duodenum was normal.The examined jejunum was normal. Approximately 180cm of small bowel could be examined during today's procedure.Two carbon black tattoos were placed in the jejunum to mark the distal extent of today's examination. Add'l Images:Tattoo Jejunum Jejunum Bleeding in stomach
Cautery Clip placement-Actively bleeding visible vessel in the body of the stomach. Treated with epinephrine injection,lectrocautery, and placement of an over the scope clip.- Otherwise normal single balloon enteroscopy with 180cm of small bowel examined. Distal extent of
today's exam marked with Carbon black tattoos.

I'm a little confused. Do I code 443255 or 44378/44370?
Thank you.

SuperCoder Answered Fri 30th of November, 2012 16:45:52 PM

Some points to consider here :

The physician is itself documenting this procedure as enteroscopy and it becomes visible too "Approximately 180cm of small bowel could be examined during today's procedure". The scope is inserted and gone beyond second portion of duodenum upto jejunum. so 43255 is ruled out. No mention of ileum in the body of report. I would go with 44366 here

When billing for tattooing, list the code for the base endoscopy procedure, followed by the unlisted code for the site of the body being tattooed. To code for the marking of lesions during a enteroscopy, for example, list 44366 first and then 44799 (unlisted procedure, intestine).

A description of the tattooing procedure must accompany the claim. Unless a description of the procedure and the purpose for doing the tattooing is attached, the claim is no good.The documentation has to support the service.

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