Heidi Posted Thu 03rd of October, 2013 14:29:00 PM
Postoperative diagnosis: Gastrocutaneous fistula
After adequate sedation the gastroscope was inserted into the mouth and advanced to the distal duodenum. Stomach had some diffuse gastritis. Esophagus had moderate to sever esophagitis. Fistula was clearly identified. Three radio clips were placed on the fistula from the gastric body then we used 3 silver nitrate sticks to cauterize the fistula tract. She tolerated the porcedure well.
please advice on a CPT code for the clips and/or silver nitrate.
SuperCoder Answered Thu 03rd of October, 2013 19:30:48 PM
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.