You can bill G0105 for a MCR patient with ICD code V12.72 (Personal Hx. of colon polyps). Constipation can be used as secondary Dx.
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SuperCoder on "Screening colonoscopy vs Diagnostic Colonoscopy"
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User id : 15406 on "IV hydration with Zofran and Solu-Cortef"
HELP! I'm driving myself crazy reading and re-reading the CPT book and past post on this issue...estab pt was seen for diarrhea with some nausea and vomitting. The physician decided to hydrate pt in the office for dehydration. THIS IS WERE I NEED HELP...
1050-SUCCESSFUL IV START RAC #22G LR 1000 ML STARTED
1105-BP -90/51, HR-60, RR-16. C/O NAUSEA 5 ON SCALE 1-10
1120-PHYSICIAN AWARE PT C/O NAUSEA - ODANSETRON 4 MG SLOW IVP GIVEN PER HIS ORDER. LOT#DM11733, EXP 6/30/2014
1140-BP 89/51, HR 62. RADIAL PULSE +2 SKIN COLOR IMPROVING
1150-PHYSICIAN IN TO SEE PT. ORDERED ADDITIONAL 500 ML LR & SOLU-CORTEF 100 MG ORDERED. WILL SEND CBC/DIFF LABS
1210-SOLU-CORTEF 100 MG SLOW IVP GIVEN. PT'S SON W/PATIENT.
1230-BP 93/52, HR - 61.
1240 - PT D/C TO HOME ACC BY HER SON AFTER SPEAKING WITH PHYSICIAN ABOUT PREDNISONE TO BE TAKEN NEXT FEW DAYS. REQUESTED PATIENT CALL IN THE A.M. TO UPDATE HOW SHE IS FEELING - SHE AGREES.
this is what i'm getting from what's listed above on how to bill:
1) 99214-25 w/ dx 787.91, 787.01, 276.51 (*e/m visit)
2) J7120 x2 w/ dx 276.51 (*1500ml Ringers Lactate)
3) 96360 w/ dx 276.51 (*1st hr hydration infusion)
4) 96361 w/ dx 276.51 (*addit 40min hydration infusion)
5) J2405 x4 w/ dx 787.02 (*Odansetron 4mg)
6) 96375 w/ dx 787.02 (addit IV push for Odansetron)
7) J1710 x2 w/ dx 787.02 (*Solu-Cortef 100mg)
8) 96375-59 w/ dx 787.02 (addit IV push for Solu-Cortef)
Is this correct?? If not please advise on the correct codes and the reason for the different codes from what i have selected above.
Thanks you soooo much!
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User id : 10209 on "EGD with Lithotripsy and stone extraction"
How would you code an EGD with lithotripsy and stone extraction in a patient with Bouveret's Syndrome? There was a large (more than 3 cm.) gallstone impacted in the duodenum removed with balloon and lithotripsy.
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SuperCoder on "IV hydration with Zofran and Solu-Cortef"
Infusion coding is very confusing and, frankly, there are a lot of gray areas when applying the codes and guidelines to real-world scenarios. In this case, you have a patient seen for diarrhea, nausea, vomiting, and dehydration. The patient receives therapy for the nausea and dehydration. The info listed doesn’t give stop times, which should definitely be documented, but based on the coding listed, it appears hydration ran for 1h 40 min. Then there’s an IVP of ondansetron for nausea and an IVP of Solu-Cortef (steroid).
With that in mind, reconsider the coding for the lines marked with ** below
99214-25 w/ dx 787.91, 787.01, 276.51 (e/m visit)
** 96374 w/ dx 787.02 (initial IV push, Ondansetron – the patient presented complaining of multiple issues, and therapy of nausea is considered to be higher in the hierarchy than therapy of dehydration; note that CPT says to use +96375 with several codes, but the initial hydration code 96360 isn’t listed, suggesting therapeutic IVP isn’t expected to be secondary to hydration)
J2405 x4 w/ dx 787.02 (Ondansetron 4mg)
** +96375 w/ dx 787.02 (addit IV push for Solu-Cortef, add-on as subsequent to 96374)
** J1720 x1, the HCPCS manual points to J1720 (100 mg per unit) rather than J1710 for Solu-Cortef, w/ dx 787.02 (Solu-Cortef 100mg)
** +96361x2, hydration, each additional hour; guidelines state +96361 is appropriate if performed secondary to 96374; dx 276.51 (1 hr 40 m hydration infusion)
J7120 x2 w/ dx 276.51 (1500ml Ringers Lactate)
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SuperCoder on "EGD with Lithotripsy and stone extraction"
These procedures are usually performed by ERCP procedure. In that case, code 43271 for balloon dilation with ERCP and code 43265 for ERCP with lithotripsy of stones.
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User id : 10209 on "EGD with Lithotripsy and stone extraction"
This was not an ERCP - No duodenoscope was used.. The therapeutic gastroscope was used. Can I use foreign body removal??
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SuperCoder on "EGD with Lithotripsy and stone extraction"
Stone is definitely not a "foreign body". And since you mention that "No duodenoscope was used", so was it just an Esophagoscopy, and not an EGD (esophago-gastro-duodenoscopy)? But since the stone was impacted in Duodenum, a simple Esophagoscopy will not do, as far as I can make out.
There is no specific code for EGD-stone removal OR Esophagoscopy-stone extraction.
Usually ERCP is performed along with Cholecystectomy for gallbladder removal and stone extraction. ERCP is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. Fluoroscopy is used to look for blockages, or other lesions such as stones.
Since the procedure is performed in duodenum, a part of small intestine, I would consider 44799, if ERCP was not the procedure that was performed. We cannot consider 43499 since iot was done on duodenum, and not in esophagus.
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SuperCoder on "EGD with Lithotripsy and stone extraction"
There is an excellent document from AHIMA, which you can refer for endoscopy guidance:
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User id : 23555 on "peg tube"
My dr did a peg placement and stated,"18F G-tube replaced with 24F G-tube then 12F Jejunal tube place through g-tube" he coded it as egd w/jejunal tube placement and egd w/gastric tube placement. I don't think I can bill both because it's the same procedure just different tubes. What would be the best cpt code for both procedures?
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User id : 63734 on "Screening colonoscopy vs Diagnostic Colonoscopy"
Thank you! Does this hold true with the chronic diarrhea as well?
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User id : 25547 on "Colonoscopy with Zofran IV infused"
Our GI group owns its own Endoscopic Suite where colonoscopies are performed in this suite we bill POS as Office.Sometimes the patient is given zofran thru the IV used for the anesthsia, would it be appropriate to charge for the zofran and the push IV code along with the colonoscopy since this is being done in an office setting?
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SuperCoder on "peg tube"
If the G tube was placed endoscopically, like via EGD process, code 43246. If G-tube was placed without imaging or endoscopic guidance, code 43760.
If it's a conversion of gastrostomy tube to G-J tube, via percutaneous process, under fluoroscopic guidance, but not via EGD, code 49446.
For replacement of a gastrostomy tube, via percutaneous process, under fluoroscopic guidance, but not via EGD, code 49450.
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SuperCoder on "Colonoscopy with Zofran IV infused"
For most office procedures, payers view the supplies as part of the procedure. Some payers will pay, many will not you should check with your payers. Do not code push IV separately as it's just the mode of anesthesia.
As a "non-routine supply", Zofran could be paid (again depending on Payer's policy) with J2405 (for each 1 mg).
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User id : 25547 on "Colonoscopy with Zofran IV infused"
Clarification on the above, our physicians do not bill for the anesthesia. We have a Anesthesiology Group that comes in and bills for all the anesthesia done at our Endoscopy suite.Since we don't bill for this would it then be appropriate to bill for the 96374 with a 59 modifier and the the Jcode for the Zofran?
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User id : 33403 on "screening colonoscopy"
I need help with the following situation:
Our Gastro doc saw a Medicare patient at the hospital and is billing 45380 with dx listed: screening, colon polyps, diverticulosis. I billed a claim to Medicare with 45380 and the primary dx was v76.51 and was denied as non-covered services bc this exam is a routine exam or screening done in conjunction with a routine exam. Not sure if we billed it correctly or do we need to bill as G0105 or is there a modifier that we can us to get it paid???
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SuperCoder on "Screening colonoscopy vs Diagnostic Colonoscopy"
Since you are performing colonoscopy for the reason "history of colon polyps", you will code V12.72 as primary Dx. You can still bill Chronic diarrhea/constipation as secondary Dx's. These will be secondary Dx only since the procedure was not performed for these symptoms.
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SuperCoder on "Colonoscopy with Zofran IV infused"
Yes, you can bill for the IV push in that case with 96374.
For Zofran, the infused drug, see payer requirement of billing HCPCS codes.
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SuperCoder on "screening colonoscopy"
Use Modifier PT with 45380.
Here is a 2011 coding alert article to give you more clearer picture.
New modifier became effective Jan. 1 -- here's how you'll report it.
The question of how to code a screening colonoscopy that becomes diagnostic during the course of the procedure -- and whether the patient's deductible applies -- has long puzzled some practices, but a new Medicare modifier solves that problem. Learn how modifier PT (CRC screening test converted to diagnostic test or other procedure) can solve your colonoscopy reimbursement woes.
Get to Know Modifier PT Basics
Effective Jan. 1, Medicare carriers accept new modifier PT to explain when your physician starts a screening colonoscopy that then becomes a diagnostic procedure.
"This tells the MAC contractor that the service started as a screening procedure (e.g. G0105 [Colorectal cancer screening; colonoscopy on individual at high risk], G0121 [Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk]) but an abnormality was found and the procedure became diagnostic or therapeutic," says Joel V. Brill, MD, AGAF, CHCQM, American Gastroenterological Association, AMA/Specialty Society Relative Value Update Committee (RUC) Advisory Committee Member.
When appended to your procedure code, "the modifier will indicate to Medicare to waive the deductible for a diagnostic procedure," says Christine Ross, CPC, with Digestive Healthcare Center in Hillsborough, N.J.
Why the change? Practices needed a way to tell MACs that their procedures started out as screening services but changed to diagnostic but didn't want patients subjected to deductibles for these services. "The Affordable Care Act waives the Part B deductible for colorectal cancer screening tests that become diagnostic," CMS noted in MLN Matters article MM7012, which announced the new modifier PT (www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf).
Avoid Reporting G Code With Modifier PT
Once the physician indicates that the screening procedure has turned diagnostic, you'll bill only the diagnostic colonoscopy code, and not the screening code (G0104-G0106, G0120-G0121). Not only is this correct coding, but it's also the only way you can use modifier PT.
The MLN Matters article notes that modifier PT should only be appended to a CPT code in the surgical range of 10000 to 69999. Therefore, you should not append modifier PT to a G code, says Brill, who represents the American Gastroenterological Association on the CPT Editorial Panel.
For example: During a screening colonoscopy for an averagerisk Medicare patient, the physician discovers several polyps. He removes the polyps (which are later determined to be benign) during the same procedure using a snare technique. In this case, you should bill the colonoscopy with polyp removal via snare technique (such as 45385, Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s], by snare technique) with modifier PT appended to 45385.
Don't Ditch 'V' Codes
Because your colonoscopy started out as a screening procedure, your diagnosis code should reflect both the screening nature of the visit and the actual condition that the physician treated.
CMS tackled this topic in MLN Matters article SE0706, with the instruction, "CMS advises that, whether or not an abnormality is found, if a service to a Medicare beneficiary starts out as a screening examination (colonoscopy or sigmoidoscopy), then the primary diagnosis should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination... Indicate the secondary diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.)." You can read this article at http://www.cms.gov/MLNMattersArticles/downloads/SE0746.pdf.
Therefore, in the example described above, the claim would appear with V76.51 (Special screening for malignant neoplasms, colon) as the primary diagnosis.
You should then append the appropriate diagnostic modifier to your claim. For example, if the surgeon removes a benign polyp from the colon, you'll report 211.3 (Benign neoplasm of colon), says Cheryl H. Ray, CCS, CPMA, CGCS, with Atlantic Gastroenterology, PA in Greenville, N.C.
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User id : 30470 on "Non medicare pt, hx of polyps colonsopy"
Pt presents for screening colonscopy for history of polyps (V12.72), during the colonscopy polyps found again (569.0) and removed by snare. (45385). What do you use for the primary dx the V12.72 or the 569.0? Additonally would it be appropriate to use the 33 modifier on the 45385 in this case?
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User id : 26350 on "procedure code(s) for gastric & esophageal stents done together"
Hello...I'm looking for a procedure code(s) for "successful deployment of 2 fully-covered wall flexes across an esophagogastric fistula at the superior margin of the gastric sleeve". Any help is greatly appreciated.
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