This is a complex case. I have forwarded this query to my Gastro Editor. He will get back soon with a definitive answer. Thanks for being patient.
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SuperCoder on "EUS with drainage of pancreatic pseudocyst"
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SuperCoder on "Laparoscopic hemicolectomy w/colocolo anastomosis and coloprocto anastomosis?"
You will report only 44207 for this procedure, as you can see the code descriptor of 44204 is already included in 44207.The patient is placed supine on the operating table and prepped and draped sterilely. The surgeon makes a small incision at the umbilicus and uses this opening to insufflate (blow gas into a body cavity) the abdomen. This lifts the abdominal wall away from the organs and improves visualization of the site to be treated. Additional small incisions are made and a camera and instruments are inserted to perform the procedure. Once the abdomen is entered and there is good visualization of the cavity, any adhesions are taken down using ascalpel, cautery, or blunt dissection. The portion of colon to be removed is cut out, usually with a stapler. The proximal end of the remaining colon is connected to the sigmoid colon or rectum. This usually requires mobilization of the splenic flexure. The surgeon assures hemostasis. The abdominal incisions are closed in layers.
Further you are correct as CCI edits do not allow both codes together also.Code 44204 is a column 2 code for 44207, These codes cannot be billed together in any circumstances.
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SuperCoder on "Laparoscopic hemicolectomy w/colocolo anastomosis and coloprocto anastomosis?"
You will report only 44207 for this procedure, as you can see the code descriptor of 44204 is already included in 44207.The patient is placed supine on the operating table and prepped and draped sterilely. The surgeon makes a small incision at the umbilicus and uses this opening to insufflate (blow gas into a body cavity) the abdomen. This lifts the abdominal wall away from the organs and improves visualization of the site to be treated. Additional small incisions are made and a camera and instruments are inserted to perform the procedure. Once the abdomen is entered and there is good visualization of the cavity, any adhesions are taken down using ascalpel, cautery, or blunt dissection. The portion of colon to be removed is cut out, usually with a stapler. The proximal end of the remaining colon is connected to the sigmoid colon or rectum. This usually requires mobilization of the splenic flexure. The surgeon assures hemostasis. The abdominal incisions are closed in layers.
Further you are correct as CCI edits do not allow both codes together also.Code 44204 is a column 2 code for 44207, These codes cannot be billed together in any circumstances.
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SuperCoder on "Laparoscopic hemicolectomy w/colocolo anastomosis and coloprocto anastomosis?"
You will report only 44207 for this procedure, as you can see the code descriptor of 44204 is already included in 44207.The patient is placed supine on the operating table and prepped and draped sterilely. The surgeon makes a small incision at the umbilicus and uses this opening to insufflate (blow gas into a body cavity) the abdomen. This lifts the abdominal wall away from the organs and improves visualization of the site to be treated. Additional small incisions are made and a camera and instruments are inserted to perform the procedure. Once the abdomen is entered and there is good visualization of the cavity, any adhesions are taken down using ascalpel, cautery, or blunt dissection. The portion of colon to be removed is cut out, usually with a stapler. The proximal end of the remaining colon is connected to the sigmoid colon or rectum. This usually requires mobilization of the splenic flexure. The surgeon assures hemostasis. The abdominal incisions are closed in layers.
Further you are correct as CCI edits do not allow both codes together also.Code 44204 is a column 2 code for 44207, These codes cannot be billed together in any circumstances.
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SuperCoder on "Laparoscopic gastrotomy"
Yes, Code 43246 includes EGD. It is inherent to the procedure .
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User id : 29994 on "screening colons with random biopsies"
physicians smoetimes do screening colons on average or high risk patients with no other indications on reports and do random biopsies. sometimes in medical records state have had some diarrhea, slight rectak bleeding etc. since procedure report itself only lists screening not sure how to code these, i feel random biopsies normally not done during screening.
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SuperCoder on "EUS with drainage of pancreatic pseudocyst"
43242 for the FNA biopsy
43256 for the stent placement (it includes dilation too)
43240 for the drainage of the pseudocyst
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User id : 15406 on "? dx code to cover lab CREATININE"
Our pt’s that need CT A&P w/contrast are required to have labs for creatinine before scan. We’ve been using dx V72.69 because it’s screening reasons for the pt having labs done. Of course this isn’t a medical necessity code and NC doesn’t have LCD’s for this lab. Should we just apply the dx codes we use for pt having CT scan??
Thanks,
Melanie
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User id : 49140 on "New CPT code 44705"
We are having a heated discussion about the use of the new cpt code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen.)
Some are saying that this code would be reported by the GI provider at the time the specimen in placed in the gi tract (either via Colonoscopy or EGD) It looks to me like it is for preparation only.
Could you please give an example of how/when this code should be used, and who(gi doc, pathologist, etc) will be reporting it?
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SuperCoder on "New CPT code 44705"
Add 44705 to Your Coding Arsenal
"We had previously covered that in 2013 we will see an end to your reporting fecal bacteriotherapy with an unlisted code." You can now update your list of codes with a code for reporting fecal bacteriotherapy, also known as a fecal intestinal transplant (FIT), when your gastroenterologist performs it. So, if your gastroenterologist performs a stool transplant, you will report part of this service with 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen).
In addition to the preparation of the donor specimen (reported using 44705), you will have to use the appropriate code for the instillation of the specimen in the gut. Depending on choice, your gastroenterologist might perform a colonoscopy, EGD, rectal enema or a nasogastric tube to instill the specimen. For example, if your gastroenterologist uses an EGD to instill the specimen, you should report 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) along with 44705 for the preparation of the specimen.
Example: Your gastroenterologist decides to perform stool transplant on a patient suffering from C. difficile infection not responding to antibiotic treatment and other forms of treatment. He decides to use a sample from the patient's spouse for the transplant. He orders a thorough assessment of the stool sample to check for communicable diseases and other parasitic infections. He then prepares a sample for instilling in the patient's gut.
Your gastroenterologist then performs a colonoscopy to instill the stool sample. You will report the services using 44705 for the preparation and assessment of the stool sample and 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) for the colonoscopy he performed to place the stool sample in the patient's gut.
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SuperCoder on "? dx code to cover lab CREATININE"
Clear V72.6x hurdle with ICD-9, coverage guidelines.
ICD-9 guidelines and direction from sources such as Medicare's laboratory National Coverage Determinations (NCDs) make it clear -- you need to code the patient diagnosis that prompts a lab-test order.
"You should encourage physicians to continue to order lab tests with condition codes rather than relying on new codes such as V72.63 (Pre-procedural laboratory examination), if you want to avoid denials"
Identify Lab Test Encounters
Now you have five new codes for lab encounters:
• V72.60 -- Laboratory examination, unspecified
• V72.61 -- Antibody response examination
• V72.62 -- Laboratory examination ordered as part of a routine general medical examination
• V72.63 -- Pre-procedural laboratory examination
• V72.69 -- Other laboratory examination.
Because patients routinely receive blood tests prior to certain procedures, and ICD-9 already provided codes for pre-procedural cardiovascular and respiratory evaluations, the ICD-9 Coordination and Management Committee (CMC) approved a request to add these labencounter codes.
Don't miss: Regarding pre-op lab exams, the ICD-9 CMC says, "These visits are generally done in an outpatient setting days before the treatment or procedure is scheduled," The new codes help explain the reason for the encounter -- but they don't necessarily explain the reason for the specific lab tests.
ICD-9 Guidelines Prioritize Diagnoses
Although V72.60-V72.69 add specificity to reporting encounters for lab tests, you shouldn't routinely use one of them as the only code for a lab exam.
Follow guidelines: ICD-9 "Official Guidelines for Coding and Reporting" state that you shouldn't use V72.6x as the primary diagnosis if you have documentation of "a sign or symptoms, or reason for a test."
"This guidance clarifies that you shouldn't start billing all pre-op or routine-physical lab tests with V72.6x," Because the ordering physician, not the laboratory, assigns the ICD-9 code, you'll need to help your physician clients understand how they should and shouldn't use the new codes. V codes describe the reason for the encounter, but physicians should still use specific condition codes to describe the signs, symptoms, or disease that show(s) medical necessity for ordered tests.
Tip: You can use physician education opportunities and requisition-form design to encourage proper ICD-9 use. Informing physicians that they need to continue ordering lab tests with condition codes will help your lab show medical necessity and get paid for ordered tests. Does that mean you can't use V72.6x as a primary diagnosis? No. ICD-9 lists the code with the ½ indicator, which means that you can use the code as a first-listed or additional diagnosis.
Limit primary diagnosis: You should only list V72.6x as the primary diagnosis "in the absence of any signs, symptoms, or associated diagnosis," according to ICD-9 official guidelines.
NCD States V72.6 Doesn't Pay
Medicare's 23 Laboratory NCDs include lists of covered diagnosis for many common lab procedures. None of the NCDs lists V72.6 as a covered diagnosis. "Because Medicare never listed V72.6 as a covered diagnosis for any of the lab NCDs, it is unlikely that you'll see V72.6x added as covered diagnoses," .
Bottom line: "If you perform diagnostic lab tests based solely on one of the new lab exam V codes, Medicare and other payers will likely determine that you haven't demonstrated medical necessity and decline to pay."
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User id : 49140 on "New CPT code 44705"
So will I need to be looking for additional documentation from my GI docs stating that they personally prepared the specimen? (Since that could be performed by someone other than the provider performing the instillation)
Normally when a fecal transplant is performed, the only statement that is documented is "120 ccs of fecal biotherapy was administred to the jejunum (or colon)". There is never any mention of pre-procedure preparation of the sample. I would like to give my providers documentation guidelines on what I will be looking for in order to bill the service.
Thank you so much for your help!
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SuperCoder on "screening colons with random biopsies"
This is tricky situation.Some experts say in this particular case, with your physician's input, they would most likely code it a screening service, and add the diarrhea as a secondary dx. It's up to the insurance company if they will still allow the patient to access their screening benefit.
A screening colonoscopy is performed on patients that do not have any GI related symptoms such as diarrhea or rectal bleeding nor do these patients have polyps or biopsies done. Most insurance packages will cover screening colonoscopies as a part of preventative medicine.
A diagnostic colonoscopy is performed on patients when GI related symptoms are occurring such as diarrhea or rectal bleeding. Please note that you may be scheduled for a screening colonoscopy, but after the procedure it will be coded diagnostic. If polyps are found during the procedure it will be considered diagnostic NOT a screening. Most insurance companies will apply diagnostic colonoscopy charges to patient’s deductibles, copayments and co-insurance amounts.
We highly recommend that you contact your insurance carrier and find out what the coverage difference is for screening and diagnostic colonoscopies.
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User id : 10209 on "Panendoscopy with Botox Injection"
Is it correct to code the Endoscopy first and the botox injection with a modifier 59? I do not see where the two are bundled anywhere or is there a more correct way to code for this procedure.
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User id : 22449 on "visceral hypersensitivity"
I need a dx code for visceral hypersensitivity
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SuperCoder on "Panendoscopy with Botox Injection"
You can report the Botox supply, but not the injection, separately from the EGD.
On the claim:
report 43236 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection[s], any substance) for the EGD with injection. (Code 43236 includes the act of injecting, so do not report any other CPT code for injections.)
report J0585 (Botulinum toxin type A, per unit) for the supply of Botox (the drug supply is not bundled into 43236).
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SuperCoder on "visceral hypersensitivity"
Look for 306.4
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User id : 49140 on "Fecal bacteriotherapy instillation 44705"
What kind of documentation should I be looking for to be able to use CPT code 44705?
I have never seen any documentation that my providers actually do the preparation of the specimen for transplant. They only docuement the installation (via colonoscopy or EGD).
Would the prep be something pathology is more likely to do?
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User id : 49140 on "Fecal biotherapy through J Tube"
What CPT code would you use for the following:
"65 cc of mildly diluted fecal biotherapy was instilled through the J tube without any immedicate problems"
Thanks!
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User id : 33948 on "Billing pathology with multiple units"
One of our Gastroenterologist performed a follow up colonoscopy on an est. pt with a 10 year history of ulcerative colitis. The physician removed a 3 mm polyp with cold biopsy forceps in the sigmoid colon. He also obtained biopsies every 10 cm because of the pts. longterm ulcerative colitis. The charge was 88305 x 13 units and 88312x 1 unit. Medicare paid for the 88312 and denied 88305.
I have tried to find the actual policy regarding maximum unit edits and have been unable to find it. I want to make sure I use modifier 59 correctly. Any advice you can give me would be appreciated.
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