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Egd with Endomucosal Resection

Jennifer Posted Wed 29th of May, 2013 20:02:35 PM

My doctor did an Egd with Endomucosal Resection. I am having difficulties finding a specific CPT code for this procedure. In the OP note it states a blue light evaluation was performed and the areas were grabbed with a band ligator followed by mucosa resection. Any help would be greatly appreciated. Thank You.

SuperCoder Answered Thu 30th of May, 2013 21:51:41 PM

There are no unique Current Procedural Terminology (CPT)* codes for EMR.The most applicable identifiers are 43236 (submucosal injection during EGD), 45381 (submucosal injection during colonoscopy), 43251 (snare polypectomy during EGD), and 45385 (snare polypectomy during colonoscopy). If adjunctive mucosal ablation of lesion margins is used, an additional code 43258 (ablation during EGD)and 45383 (ablation during colonoscopy) can be attached to the primary procedure code. Ordinarily the polypectomy (highest reimbursed of existing CPT codes) would be listed first, and –59 modifier attached to other reported codes. Use of the modifier 22 (unusual procedural services) can increase the reimbursement for the procedure, but the details of how the services were more extensive than the standard procedure must be documented in a cover letter or within the report. An alternative to the –22 modifier is to code an unlisted 47999 code appended to the polypectomy code adding the –59 modi-fier billed at a fee judged appropriate for the EMR. In this last case a cover letter submitted with the claim that explains the nature of the procedure, equipment required,estimated practice cost, and a comparison of physician work (time, intensity, risk) with other endoscopic services for which the payer has an established value should be included to the payer. A center performing this procedure frequently might find it worthwhile to arrange a personal discussion between an endoscopist and the medical director of larger payers to facilitate coverage and appropriate pricing. The dedicated EMR and ESD devices do add to the facility cost of the procedure largely without added reimbursement.

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