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Is unsuccessful attempt at control of bleeding during EGD billable as 43255

Nellie Posted Tue 11th of February, 2020 11:18:08 AM
We did an EGD on a patient having hematemesis, anemia and weakness after a recent Whipple procedure. EGD showed hemorrhagic gastropathy and bleeding at staple line of anastamosis. We attempted hemostasis with epinephrine injections but this was unsuccessful. Patient later went for surgical oversew of staple line. My question is - since the doctor attempted hemostasis with injection, can we bill for the 43255 even though it was not successful at stopping the bleeding. I hate to bill for a basic EGD when he did the work. Thanks!
SuperCoder Answered Wed 12th of February, 2020 08:28:23 AM

Hi Nellie,


Thanks for your question.


As per the limited documentation, it is mentioned that the patient had a recent whipple procedure therefore, it is important to append modifier 78 with the procedure code performed today.


Secondly, the provider performed the EGD with control of bleeding but he was unsuccessful. Since, the complete procedure was performed with unsuccessful outcome code 43255 is appropriate to use.


But you also mentioned that, later the patient went for surgical oversew of staple line. Therefore, if this procedure is performed in the same session then code for the surgical oversew of staple line should be used but not for EGD with control of bleeding.


Hope this helps.

Nellie Posted Wed 12th of February, 2020 10:12:34 AM
Thank you for the quick response!
SuperCoder Answered Wed 12th of February, 2020 23:28:47 PM

Thank you, happy to help.

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