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Unlisted procedure code?

Sandeep Posted Thu 13th of February, 2020 05:19:40 AM
Subepithelial mass lesion was seen in the gastric fundus with normal overlying mucosa.The lesion was then identified. The tip of the T-type hybrid knife from ERBE was used. The marking was made with soft coagulation current 80 watts, effect 5. With repeated submucosal injection of saline mixed with methylene blue and epinephrine, the submucosa was raised. I performed a circumferential incision around the lesion. The overlying mucosa was resected using the hot snare. The whitish irregular mass lesion was noted. The submucosa was cut furthermore. A knife was then used. Full thickness resection was performed. At this time, CO2 was shut off. The mesenteric fat was seen coming into the gastric lumen. Snare was used to resect the tumor and pulled it all the way out. Please suggest CPT code for this procedure.
SuperCoder Answered Fri 14th of February, 2020 11:07:36 AM

Hi Sandeep,

Thank you for your question.

The closest code available for the resection of tumor with snare technique is 43251 ( Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique). Feel free to ask for any further query.

 

Sandeep Posted Mon 17th of February, 2020 01:22:33 AM
The procedure mentions that T type hybrid knief from ERBE was used. Only snare has not being used. What is the possibility of using an unlisted code for stomach 43999. Please clarify.
SuperCoder Answered Wed 19th of February, 2020 07:37:59 AM

>Hi Sandeep,

>Even if you use unlisted CPT code 43999, payer will pay for your unlisted code as per the nearest comparison code that can be related for your performed services. In that case your comparison CPT code would be 43251 and you would be reimbursed dollar value equivalent or round off the dollar value assigned to CPT code 43251.

>It would be wise to bill CPT code 43251 for the performed service.

>Thanks!

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