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Sherry Posted Wed 22nd of November, 2017 10:36:09 AM
I have an EUS that is being done on a patient, the physician has done the following and i'm conflicted if i need to use the injection code or the unspecified code: "Endosonographic imaging of the pancreas showed sonographic changes indicative of moderate-severe chronic pancreatitis in the entire pancreas. The parenchyma had diffuse echogenicity, hyperechoic strands, hyperechoic foci, hypoechoic foci and lobularity. The pancreatic duct had duct dilation. The pancreatic duct measured up to 3 mm in diameter. Endoscopic Finding : A previously placed cystgastrostomy stent was found in the gastric body. LAMS were removed. Type 1 isolated gastric varices (IGV1, varices located in the fundus) were found in the cardia. There were stigmata of recent bleeding. They were medium in largest diameter. A 22G needle was advanced into the gastric feeder varix and multiple 0.018 2 cm coils were deployed to ablate the varix" Which is the right CPT codes to use in this case? Would is be 43259 and unspecified or would you bill this as an injection code?
SuperCoder Answered Thu 23rd of November, 2017 06:55:22 AM

Hi, 

There is no specific code for the above stated procedure. CPT code 43259 seems to be correct for one part of above stated procedure. It seems appropriate to use unspecified code for this scenerio.

 

Hope this helps!

Sherry Posted Mon 27th of November, 2017 08:59:30 AM
Great, so you definitely agree that CPT code 43253 shouldn't be used for the Coil injection then right? That was where we were conflicted on.
SuperCoder Answered Tue 28th of November, 2017 06:35:25 AM

Hi, 

CPT code 43253 is used for examination of  the upper gastrointestinal tract and  transendoscopic ultrasound-guided transmural injection. There is no such specific code for above stated procedure.

Hope this helps!

Sherry Posted Mon 25th of June, 2018 13:23:59 PM
On the above coil deployed should this be used as a bleeding control since the patient has a history of bleeding and the there is recent stigmata of bleeding and they are deploying the the coils for ablate to varix so they wont bleed again
SuperCoder Answered Tue 26th of June, 2018 08:00:52 AM

Hi Sherry,

 

Endosonographic imaging was performed on pancreas. There is no specific code for ultrasound imaging of pancreas. Therefore, CPT code 43238 would be the most appropriate code for the ultrasonic guidance of stomach and adjacent structures because pancreas is an adjacent organ to stomach. In the second scenario with statement coils were deployed to ablate the varix CPT code 43255 seems appropriate. Since this CPT code involves control of bleeding through all methods. Therefore, CPT code 43255 seems to be the most appropriate code. Hence bill CPT codes 43255-59 and 43238-52.

 

Modifier 52 is appended as EGD is the part of both procedures.

 

Modifier 59 is appended to unbundle the NCCI edit.

 

Hope this helps!

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