Sherry Posted Mon 27th of November, 2017 09:05:23 AM
Can you help confirm if this can be done Endoscopically? The physician is stating the following:
"A Fistula was found in the gastric body. Internal closure of PEG ostomy/fistula, a OVESCO clip was placed. One ligature was successfully placed. "
Are we billing this as 43235 and an unlisted code in the stomach? Normally I have seen this as an Apollo Overstich, which then we normally bill the Stent placement and unlisted code; I just wasn't 100% sure this was what was being done since it wasn't mentioned and PEG/ostomy was involved as well.
SuperCoder Answered Tue 28th of November, 2017 00:39:11 AM
Hi, the information provided is not sufficient to decide if the given code will be appropriate in this scenario. Please send the procedure details for us to help you with the correct coding. Thank you.
Sherry Posted Tue 28th of November, 2017 13:01:11 PM
Thank you for your help, here is the procedure details:
The upper third of the esophagus, middle third of the esophagus and
lower third of the esophagus were normal.
The Z-line was regular and was found 45 cm from the incisors.
The gastric fundus, gastric body, incisura and gastric antrum were
normal. There was bile refluxing into stomach from the small bowel.
A fistula was found in the gastric body. Internal coluse of PEG
ostomy/fistula, a OVESCO clip was placed. There was no bleeding during,
and at the end, of the procedure. One ligature was successfully placed.
There was no bleeding during the procedure.
The duodenal bulb and 2nd part of the duodenum were normal.
Impression: - Normal upper third of esophagus, middle third of
esophagus and lower third of esophagus.
- Z-line regular, 45 cm from the incisors.
- Normal gastric fundus, gastric body, incisura and
- Gastric fistula- Internal coluse of PEG ostomy/fistula
with OVESCO clip.
SuperCoder Answered Wed 29th of November, 2017 01:15:47 AM
Since there is no specific code for endoscopic closure of gastrostomy/fistula closure with OVESCO clip, only code 43999, Unlisted procedure of stomach, should be appropriate to bill. While submitting the code, please be sure to mention the description of the procedure and submit a cover letter and operative report in support of your code. This separate report should explain, in simple, straightforward language, exactly what the physician did. Hope this helps. Thank you.