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To code 43200 does the entire esophgus have to be viewed?

Angelica Posted Fri 14th of December, 2012 13:57:41 PM

The intended procedure was Upper GI endoscopy. Documentation states
"Normal at the cricopharyngeus and into the proximal esophagus. At this point the patient reached up and pulled the endoscope out"--we know we cannot code the upper GI, question is-for CPT code 43200 does the entire esophagus have to be viewed-or should 43200 be coded with modifier 52?

SuperCoder Answered Fri 14th of December, 2012 20:13:33 PM

The spring '91 CPT Assistant says to use -52 for attempted procedures. Here is an excerpt:

"...modifier -52, reduced services, is used to describe a situation when a service or procedure is partially reduced or eliminated at the physician's election. For example, a flexible fiberoptic esophagoscopy was ATTEMPTED and the physician could not complete the entire procedure due to obstruction or other complication, you would report 43200-52 to describe that the procedure was reduced.

Since your procedure is not attempted and scope was inserted into esophagus report 43200 completely.

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