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GI control of hemorrhage codes

Polly Posted Tue 27th of March, 2012 16:10:24 PM

Can I use the control of hemorrhage codes when treating or clipping
a suspected or recurrent source of a bleed ? Unclear of what to do if there is not a current bleed at the time of endoscopy.

Thanks for the help

SuperCoder Answered Tue 27th of March, 2012 21:41:17 PM

Yes you can use the hemorrhage codes. eg 43255 includes any method. If there is not a current bleed at the time of endoscopy and nothing was performed to control, simply report diagnostic endoscopy .

Carol Answered Wed 04th of April, 2012 15:44:23 PM

Please explain how you are coding. 43255 is the CPT for control of bleeding BUT how do you bill for a diagnostic endoscopy when you already stated that it was a bleed. I am afraid I do not agree with this. There is a philosophy that states - If it isn't broken don't fix it BUT if you choose to, you do it without reimbursement. Not too sure if this is a Medicare patient but it it was and you were required to send in your endoscopy report, Medicare would quickly ask you to reimburse them this code. If the patient had underlying circumstances such as coagulapathy, I would make sure that the diagnosis code stated this.

SuperCoder Answered Thu 05th of April, 2012 08:42:34 AM

As Polly has aksed in the original question, theer was a "suspected or recurrent source of a bleed". The word "recurrent" tells me that after doing EGD some time in past, there was some bleeding too. that might have occured several times, but it had happened earlier. Now at the current encounter if the surgeon gets into the cavity to find out bleeding (or after finding out that bleeding is taking/taken place), he would certainly perform a surgery to stop this recurrent bleeding. So the main cause of the surgery is to stop recurrent bleeding, either from the current oozing site, or from a highly suspected site (when right at that time no bleeding is happening). As long as the target of the surgery is to stop bleeding, treat bleeding site, you can report 43255, but do not code 43235 (diagnostic EGD) since diagnostic service is always included within procedural code......

But when there is no current bleeding, but physician decides to look into it to find cause/source of bleeding and performs EGD, but do not see any bleeding site/incidence, and if he simply explores the organs and takes out the instrument without performing any surgery, just bill 43235 (no 43255 this time since there is no surgical tretament performed). recurrent bleeding can be the primary diagnosis code for either of the cases.

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