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Rigid EGD for minor under 1 year old

Christina Posted Fri 01st of November, 2019 08:28:41 AM
I do anesthesia billing. We use the CPT code and crosswalk it to an ASA code. I have a patient who is under 1 year old who had a rigid EGD with foreign body removal. The code I chose for the the EGD is 43194 but it crosswalks to 00320. This asa code is for anyone over 1 year old. Can you please review the scrubbed Operative note and give a suggestion as to which code needs to be used? Patient was brought to operating room and placed in a supine position. After induction the patient had a rigid esophagoscope passed into the proximal esophagus. Coin was identified and removed with a grasper without difficulty. Second pass with scope revealed no additional foreign bodies. Patient was awakened and taken to the PACU is stable condition.
SuperCoder Answered Mon 04th of November, 2019 07:39:36 AM

Hi,

Thanks for your question.

The correct code for esophagoscopy with foreign body removal is 43194 and the ASA crosswalk is 00320. You are correct that the code 00320 is used for 1 year or above. In this scenario the patient is 1 year younger. Therefore, you can assign a circumstances code for anesthesia i.e. 99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70).

This code, depicting the "age criteria", is a qualifying circumstance CPT®. This is an add–on code, used along with a primary anesthesia procedure code, and is applied only in cases when the patient's age is less than 1 year or more than 70 years. At the time of billing for any anesthesia service provided to a patient, checking the patient's age becomes an important criterion. Documentation of the patient's age in the medical record by the physician is absolutely necessary for using this code.

Code 99100 is not payable by Medicare.

You can also get the reference from the Tips section in the lay term column of code 00320 in Supercoder.com.

Hope this helps.

Thanks.

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