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43255 versus 44366

Maarit Posted Mon 23rd of January, 2012 20:31:10 PM

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.

Maarit Posted Thu 26th of January, 2012 00:58:47 AM

Could someone please help me understand the difference between 44366 and 43255? See the question above.

SuperCoder Answered Thu 26th of January, 2012 21:58:19 PM

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

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