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Disagreement re: EGD coding

Melanie Posted Thu 27th of May, 2010 13:42:22 PM

OK... I have dictation that CLEARLY states only the esophagus and the pouch-stomach was viewed of a status-post gastric bypass patient having issues with N/V and abdominal pain. I have indicated to them that their dictation does not indicate they went to and through the duodenum and I am refusing to use the CPT they have indicated.

I cant seem to locate an appropriate CPT for what was truly viewed (no surgical intervention was done)

Thoughts?

Alan Answered Thu 27th of May, 2010 14:07:42 PM

Which instrument was used? Was EGD done or only an esophagoscopy was performed? If EGD was done, sans duodenum view, you may try with 43235 with modifier 52. If it was only an esophagoscope, you can code 43200 or 43234.

SuperCoder Answered Thu 27th of May, 2010 14:27:48 PM

Since, the patient had a status post gastric bypass,( where the physician partitions off a small section of the stomach (usually with staples) and divides the small intestines. The physician then attaches one portion of the small bowel to the new stomach pouch and uses the other (distal) portion of the bowel to create a “bypass” before rejoining it to the main portion of the small intestine) so here the duodenum is bypassed. To get a more clearer picture check this image" http://www.saintpatrick.org/uploads/images/RouxEnY-Gastric-Bypass.jpg"

So I can say that the physician is correct to bill the complete CPT code for the EGD procedure in this scenario. Also use the gastric bypass status (V45.86).

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