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Colonscopy w/snare and hemostatic clip placed.

Marianne Posted Thu 13th of March, 2014 10:47:34 AM

The polyp was removed with the hot snare. Resection and retrieval complete. Hemostatic clips were placed. What code would I use for the hemostatic clips?

SuperCoder Answered Fri 14th of March, 2014 09:43:45 AM

Report nothing for the hemoclip placement.

ENDOCLIPs are a form of surgical closure/surgical tool - There would not be a specific CPT surgical code for placement of ENDOCLIPs as they could be considered incorporated in the actual closing. In the information it appears to continue to support that just about any code for a given procedure could use ENDOCLIPs or hemoCLIPs if they are controlling bleeding etc so there could be many CPT codes where a surgeon uses these supplies/tools. ICD-9 Coding Clinic, Vol 19 No 4, 4th Qtr 2002 Section 1 "The most common presenting symptom is recurrent, often massive, hematemesis associated with melena (51%). Usually, there are no symptoms of dyspepsia, anorexia or abdominal pain. The lesion is usually identified during ENDOscopy or urgent laparotomy. Occasionally, the diagnosis can be made angiographically. Treatment usually consists of therapeutic ENDOscopy with bipolar electrocoagulation, monopolar electrocoagulation, injection sclerotherapy, heater probe, laser photocoagulation, epinephrine injection, hemoCLIPping or banding." Gastroenterology Coder's Pink Sheet Effective Date 10/01/2005 Publish Date October 2005 Subject No additional payment for hemoCLIPs or ENDOCLIPs "In gastroenterology, your physician may use a surgical tool, or CLIP (eg, hemoCLIP, ENDOCLIP or brand name HemoCLIP), to control a gastrointestinal bleed or to serve as a MARKER for later surgery. The concern has been whether an additional service can be reported when these devices are used. The answer appears to be no. The devices are to be considered like other ENDOscopic techniques, such as thermal application (laser, heater probe, and bicap) and local injection (hypertonic saline, epinephrine, and ethanol) to control a bleed, and as a MARKER, like India ink, for surgical resection and later reexamination of the gastrointestinal tract. With the hemoCLIP, the gastroenterologist is often attempting to achieve mechanical hemostasis by the application of the metal hemoCLIP to a bleeding vessel. In non-hemostatic uses, CLIPs have been used not only as MARKERs, but noted for their use in tissue defects, perforations and anastomotic leakage in the esophagus, stomach and colon, and to aide in the placement of enteral feeding tubes. “There is no code for that,” explains Lisa Poppenhouse-Davis, CPC, reimbursement specialist, Internal Medicine Billing Office (14 gastroenterologists, multiple sites), University of Texas Southwestern Medical Center, Dallas. “You don’t add anything. It is just the type, whatever you are using, as your means to stop the bleeding. We haven’t charged anything extra for it.” Code the procedure for the service that is performed. For instance, if you perform an upper GI ENDOscopy with a hemoCLIP, report the control of bleed code, 43255 (upper GI, including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method). If the CLIP is being used as a MARKER, report the service performed, eg, biopsy, eg, 43239, polypectomy, eg, 43250 or 43251, or injection, eg, 43236. The same logic applies if the CLIPs are used for control of bleed or as a MARKER for an esophagoscopy, ENDOscopic retrograde cholangiopancreatography (ERCP) or colonoscopy.

Source: AAPC

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