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EGD with APC for gastrocutaneous fistula

Suzanne Posted Thu 02nd of February, 2012 15:07:45 PM

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.

I wonder if 43258 would be appropriate with 22 since doctor put 3 more clips. or 43236 with 22.

Thank you

Julie Agus

SuperCoder Answered Tue 14th of February, 2012 11:32:13 AM

The current Px was for removal of gastrocutaneous fistula via EGD. You can code this with 43258. The reason for surgery was fistula removal, not bleeding control, therefore you cannot code 43255 (for EGD with APC usage). Any intraprocedural bleeding control, if done by APC, would not be coded separately. And modifier 22 is not required here since only 3 additional clips were placed, which would not have taken much time afetr the surgery. Modifier 22 can be appended ONLY when there is clear documentation that physician used good amount of increased time for certain services, which does not seem to be the case here.

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