I need a cpt code for a GASTROGRIFIN ENEMA
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User id : 22449 on "GASTROGRIFIN ENEMA"
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SuperCoder on "GASTROGRIFIN ENEMA"
The procedure should be reported using 74270 (Radiologic examination, colon; contrast [e.g., barium] enema, with or without KUB).
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User id : 34267 on "Double balloon endoscopy"
I am looking for a code for a 'double balloon endoscopy' where the physician enters the small bowel during a colonoscopy. Any help?
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SuperCoder on "Double balloon endoscopy"
Enteroscopy is a procedure used by your gastroenterologist to view the small intestine. Another method used to visualize the small intestine is to use capsule endoscopy. However with capsule endoscopy, your gastroenterologist will only be able to visualize the small intestine and will not be able to perform any additional procedures, like taking a biopsy specimen.
Your gastroenterologist might use different techniques for enteroscopy. The three different techniques used by gastroenterologists for enteroscopy include:
Single balloon enteroscopy
Double balloon enteroscopy
Spiral enteroscopy
Note that there are no separate CPT® codes for the different techniques of enteroscopy your gastroenterologist might use. Instead, while choosing the right code to report you will have to concentrate on the following guidelines:
The approach used -- The most common approach is through the mouth (antegrade approach) although sometimes your gastroenterologist might view the distal portions of the ileum using a retrograde approach through the rectum.
The extent to which the small intestine was visualized
The purpose of the procedure (such as visualization, biopsy, removal of a lesion using a snare, control of bleeding, etc)
Example: If your gastroenterologist used a spiral enteroscopy procedure to visualize the small intestine through an antegrade approach, then you can use 44360 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) if your gastroenterologist did not visualize the ileum and 44376 (…including ileum…) if the entire small intestine including the ileum was visualized.
Suppose during the procedure your gastroenterologist took a biopsy specimen, then you have to report the procedure using 44361 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple) or 44377 (…including ileum…) depending on the extent to which the scope was advanced.
Instead, if your gastroenterologist used a retrograde approach for the enteroscopy procedure, you will have to use the unlisted procedure code 44799 (Unlisted procedure, intestine) as there is no separate CPT® code to report the procedure done using a retrograde approach.
Bill it with 44376-22 since DBE itself a small bowel endoscopy much more prolonged and involved different technology. The procedure generally takes 2-3 hours.
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User id : 34267 on "Double balloon endoscopy"
By 'retrograde approach' are you saying the gastroenterologist enters the ileum when while doing a colonoscopy?
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User id : 23555 on "icd 9"
what is the dx code for Lynch Syndrome?
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User id : 34267 on "Modifier 22"
Can a modifier 22 only be used with a physician fee code or can it also be used with the ASC coding where a procedure was done?
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SuperCoder on "icd 9"
Lynch Syndrome is Hereditary Nonpolyposis Colorectal Cancer (HNPCC). Look at codes in the range 153.0 to 154.1.
Status Code:
V84.09
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SuperCoder on "Modifier 22"
When properly applied, modifier 22 Increased procedural services allows a physician to receive greater reimbursement for an especially difficult or time-consuming procedure. But getting modifier 22 claims paid requires more than just extra work in the operating room—it also means a greater effort when documenting and submitting the claim.
Master the Basics
As explained in CPT® Appendix A, modifier 22 indicates that the work performed during a particular procedure was “substantially greater than typically required…” Neither CPT® nor the Centers for Medicare & Medicaid Services (CMS) guidelines precisely define a “substantially greater” effort. As a practical matter, you should follow specific payer requirements (e.g., some payers require that the work be “at least 25 percent greater than usual”). Regardless of payer, you should append modifier 22 infrequently, for only the most unusually difficult procedures.
Not Every Difficult Procedure Merits Modifier 22
Medical practice is inherently “difficult,” but difficulty alone doesn’t justify appending modifier 22. The procedure must be unusually difficult in relation to other procedures of the same type.
CPT® codes (or, more precisely, the values assigned to those codes) assume an “average” service. Patient A’s cholecystecomy on Tuesday may go more smoothly than Patient B’s cholecystecomy on Thursday. Rather than price each cholecystecomy individually, the payer reimburses a standard amount with the assumption that the “easier” and “more difficult” cases will average over time.
Only rare, outlying cases—those that are far beyond the average difficulty—call for modifier 22. As the American Medical Association’s (AMA’s) CPT® Changes 2008 explains, “This modifier should be used only when additional work factors requiring the physician’s technical skill involve significantly increased physician work, time, and complexity than when the procedure is normally performed.”
Modifier 22 is for physician reporting only (facilities may not report modifier 22), and should not be appended to evaluation and management (E/M) codes, according to CPT® guidelines. Most commonly, modifier 22 will accompany surgical claims—although modifier 22 also might apply to anesthesia services, pathology and lab services, radiology services, and medicine services. Circumstances that may call for modifier 22 include the following:
Increased service intensity or procedural time
Increased technical difficulty, or physical and/or mental effort
An especially severe patient condition
Specific instances when you might apply modifier 22 could include extensive scarring from a previous injury or surgery, excessive patient blood loss for the particular procedure, trauma extensive enough to complicate the particular procedure (but not billed as additional procedure codes), anatomical variants, or even morbid obesity in a patient that makes a procedure much more difficult than is typical.
Do not apply modifier 22 if another CPT® code (including an unlisted procedure code) more accurately describes the performed procedure. To give an example, if the surgeon performs laparoscopic hiatal hernia repair using mesh, do not report 43332 Repair, paraesohageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis with modifier 22 appended to describe the mesh placement. Instead, report 43333 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis, which appropriately describes the procedure (including mesh placement) without the need of a modifier. In other words, modifier application shouldn’t be a factor in code selection, but only to alert the payer that there is something “unusual” about the claim.
State Your Case
Knowing when and how to append modifier 22 is less than half the battle. The real work, from a claims submission standpoint, is justifying to the payer that the modifier is appropriate in a particular circumstance, so the additional payment is warranted. Put yourself in the payer’s place: You’ve agreed to standard payment for a particular service, but the provider—by appending modifier 22 to her claim—is asking for over and above this amount. Before you pay anything extra, you’re going to want reasons, right?
As always, support for the claim rests on the strength and detail of the provider’s documentation. AMA instructions specify, “Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.”
The operative note should include a clear description of the procedure, as well as identify additional diagnoses, pre-existing conditions, or any unexpected findings or complicating factors that contributed to the extra time and effort spent performing the procedure. Ideally, the documentation will include a concise statement that explains the nature of the unusual service, with pertinent, supporting portions of the operative note highlighted.
In the “old days,” best practice was to include a cover letter detailing the actual intra-operative work. Because most claims now are sent electronically, you instead should include comments in the narrative field, using everyday language to explain precisely why, and how much, additional work and/or time were required. For example:
“Due to anatomical issues of obesity we had to lyse adhesions for over an hour to get to the surgical field.”
“We had to make four attempts to place the guide wire due to plaque prior to the start of the cath.”
The “comments” also should include the statement, “Request documentation if needed.” Sometimes what is put in the narrative field is enough to get the claim paid (depending on the insurance company). If more detail is requested, be prepared to send the full note with all of the difficulties highlighted. The provider should sign the cover letter, and include a personal statement of difficulty. This could be as simple as a time comparison (typical vs. increased difficulty), along with an explanation of why the extra time was necessary.
Finally: You have to ask for the money. Don’t assume the payer will increase reimbursement because it sees modifier 22. As part of your cover letter, recommend an appropriate payment. For instance, if a surgical procedure requires twice as long as necessary due to unusual clinical circumstances, you could ask the payer to increase the intra-operative portion of the payment by 50 percent. You may not get the full amount requested, but if you don’t ask, you could end up with the standard payment only. Bear in mind that Medicare gives carriers wide latitude in pricing these claims.
Expect a Claims Review
CMS and other payers watch modifier 22 claims carefully. As a rule, primary payer claims submitted with modifier 22 will be subject to a full medical review. If your claim is correctly coded and well supported, be persistent in pursuing payment.
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User id : 35049 on "OV for colon screen with other diagnosis."
PCP’s will send Medicare patient to our office for a “screening colonoscopy”. There are times the patient will have other issues as well. Ex: GERD or Esophagitis. Can the doctor bill for an office visit because the patient has presented will a problem? The doctor will be doing a colonoscopy and the EGD if appropriate. Thank you.
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User id : 25547 on "Pelvic Floor Dysfunction ICD-9 code"
Some of our GI patients have Pelvic Floor Dysfunction and we have been using 625.5 or 739.5 as the icd-9 code. Need some feedback on what others may be using for PFD and what would be the most appropriate code.
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SuperCoder on "Pelvic Floor Dysfunction ICD-9 code"
There is no specific code for this. Taking into search we should inclined to use 739.5. or a more generalized code 625.9
625.5 is incorrect to use 'Pelvic congestion syndrome'
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SuperCoder on "OV for colon screen with other diagnosis."
Your doctor is providing two services. The first is the colonoscopy itself. According to CPT, colonoscopy, whether diagnostic or screening in nature, would typically be coded with 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).” Medicare, of course, has its own codes for screening colonoscopies: G0105 for individuals at high risk and G0121 for other Medicare beneficiaries. For screening colonoscopy, use an appropriate diagnosis code (e.g., V76.51, “Special screening for malignant neoplasms; intestine; colon”) to reflect the screening nature of the service. For diagnostic colonoscopy, use a diagnosis code that reflects the pertinent findings of the procedure or the symptoms that prompted it.
The other service you asked about is an evaluation and management (E/M) service. If it is not significant and separately identifiable from the evaluation/exam typically done prior to a colonoscopy, your doctor should not report it separately. If it is significant and separately identifiable, then he can code it as either a consultation or an office/outpatient visit. Whether he can code it as a consultation will depend on whether you have requested his advice or opinion regarding evaluation and/or management of a specific problem and whether he provides you, as the requesting physician, with a written report in return. It may also depend on your business relationship with him. Some payers do not recognize consultations between physician partners or physicians of the same specialty in the same group practice. If the E/M service is significant and separately reportable and otherwise does not meet the definition of a consultation, the office encounter should be coded using an office/outpatient visit code, such as 99213. In either case, modifier -25 should be appended to the E/M code to indicate that it was a significant, separately identifiable service from the colonoscopy done on the same date.
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User id : 35049 on "OV for colon screen with other diagnosis."
Sorry may not have stated the problem the right way. Our DRS prefer to see patient's in our office before they schedule a screening colonoscopy,for a different day. The patient will come to the office the doctors will discuss the procedure and then the patient will go to our scheduler. We do not charge for this office visit. There are times, however, when the doctor (from ROS) or the patient will discuss issues other than the colonoscopy. These issure usually have to do with UGI. When issues with the UGI have been discussed can he bill for that office visit with the UGI DX code? Thanks
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User id : 26350 on "procedure code(s) for gastric & esophageal stents done together"
Hello...I posted a question 4 wks ago. I wonder if anyone has an answer for me.
"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". Thank you.
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SuperCoder on "procedure code(s) for gastric & esophageal stents done together"
Hi,
We apologize for the delay. This was skipped from the database. I will answer you soon.
Thanks
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User id : 63734 on "Screening and Diverticulosis"
When a doctor goes in to do a Screening Colonoscopy and finds Diverticulosis 562.10. Can it still be a G0121 due to diverticulosis being an incidental finding? I have read many conflicting answers.
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SuperCoder on "Screening and Diverticulosis"
Hi,
I am working on this and will answer soon.
Thanks
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SuperCoder on "Screening and Diverticulosis"
Hi,
I am working on this and will answer soon.
Thanks
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SuperCoder on "Screening and Diverticulosis"
The finding like 562.10 or 455.x, is what we refer to as incidental. You can code and bill those, but as secondary dx, the intention was screening, and it should stay screening with G-code.
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