Hi Eleen,
Good Observation and good work on codes also.
The last line "The exam of the esophagus was otherwise normal." clearly signifies that the procedure was limited to esophagus only. Hence the code sets 43217 and 43232 are viable here.
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on "43259 & 43251 or 43217 & 43232"
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on "43259 & 43251 or 43217 & 43232"
Great!!! Thank you so much for your help.
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on "Upper GI-repositioning Stent"
Procedure:
The previously placed fully covered esophageal stent had migrated into the stomach. The partially obstructing esophageal
mass in the distal esophagus was traversed with the 9mm gastroscope. There was some retained liquid within the
stomach that was removed with suction. Using a rat-toothed forceps, the migrated esophageal stent was pulled back into
the esophagus and repositioned under fluoroscopic guidance so that it was traversing the esophageal mass. The proximal
edge of the stent was then secured to the esophageal mucosa with three hemoclips to help reduce the risk of migration.- Previously placed fully covered esophageal SEMS had migrated into the stomach.
- This was repositioned across the esophageal mass under fluoroscopic guidance.Three hemoclips used to help reduce the risk of stent migration.
Will this just be cpt 43235?
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on "EGD WITH BX FOR CLOtest"
Can the physician bill for the CLOtest "87081" in a outpatient setting?
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on "Upper GI-repositioning Stent"
As no new placement/insertion of stent is there, I would also go with 43235 here.
Code 43256 is the only one code you can bill for the stenting procedure which includes the insertion of the scope, guidewire placement, tumor dilation (predilation with a balloon dilator) and stent deployment. All of these services are included in the fee for the stent placement, and cannot be billed separately.
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on "EGD WITH BX FOR CLOtest"
This code is not an ASC/Outpatient approved procedure.
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on "ERCP + 43273"
As far as I know when doctor views inside the ducts with a second device inserted through the ERCP scope, then I can use +43273 besides I must be sure that ERCP (43260, 43261, 43263-43265 and 43267-43272) is done too. I am aware also when he says that cholangioscopy/pancreatoscopy in the report then I can bill that with +43273.
My problem is most of the time the way GI doctor describes it is not that clear. Sometimes He doesn't mention the use of spyglass, or he doesn't mention that bile duct empties into the lower intestine, neither does he state that common bile duct or pancreatic duct is viewed. But he always mention cholangiogram is performed.
e.g.: Using a standard sphinterotome guide wire, a wire guided selective cannulation of the common bile duct was done, pantreatic duct was not cannulated. The cholangiogram showed dilated common bile duct etc etc
question:
If selective cannulation of the common bile duct was done, does it mean doctor wants to view the bile duct? then I can use +43273? and Cholangiogram is performed. Isn't that not enough information to assume that spyglass is used in this case. how can I tell that ERCP is done with or without dirrect visualisation of Bile duct. Is there any particular term that I need to pay attention to in order to know that I need to bill it with +43273
I would appreciate any inputs regarding this direct visualization code.
Thank you
Julie Agus
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on "ERCP + 43273"
Documentation: You should look for evidence in the physician's notes that she cannulated, entered, or penetrated the papilla of Vater, which is where the bile duct empties into the lower intestine, or that she viewed the common bile duct or pancreatic duct.
This is good to go with 43273.
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on "43239 & 43236"
Findings:
One superficial gastric ulceration with no stigmata of bleeding was found in the gastric antrum. The lesion was 4 mm in
largest dimension.
Localized moderately friable mucosa with overlying exudate was found in the gastric body possibly from iron. Biopsy with
a cold forceps was performed for histology. Estimated blood loss was minimal.
LA Grade D (one or more mucosal breaks involving at least 75% of esophageal circumference) esophagitis was found in
the lower third of the esophagus. Biopsy with a cold forceps was performed for histology. Estimated blood loss was
minimal.
Area was successfully injected in four quadrants with 100 units botulinum toxin.
can it be coded 43239 & 43236?
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on "leak from staple of ileum"
I need an ICD-9 code for a recurrent leak from stapled end of the ileum. Postoperative open abdomen with stapled distal bowel status post extensive small bowel resection secondary to strangulated.
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on "43239 & 43236"
Correct 43239 and 43236-59
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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on "leak from staple of ileum"
I would recommend using 569.83 for this.
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on "sigmoidoscopy decompression volvulus and rectal tube placement?"
I was under the impression that a rectal tube placement after sigmoidoscopy decompression volvulus would be included? Or would coding 45337 with the unlisted 44799 for the rectal tube placement be acceptable?
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on "can you bill a rigid proctosigmoidoscopy w/ mod -59 when done w/lap colectomy?"
I was told to bill code 45300 mod -59 when dictated in op note along with colectomy of any sort basically. according to CCI edits this is allowed. I am just wondering if it is appropriate and if otheres are billing this way?
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on "can you bill a rigid proctosigmoidoscopy w/ mod -59 when done w/lap colectomy?"
You can’t override any of these new digestive-system edits by attaching a modifier to your claims.The exact Column 1 codes differ slightly for each of these codes. But the comprehensive codes generally include all of the codes in the endoscopy section of digestive surgery (45300-45392).
Component codes include laparoscopic fundoplasty code 43280; bariatric surgery codes 43644-43653, 43770-43774 and 43886-43888; digestive laparoscopy codes 44186-44188, 44204-44212 and 44227; laparoscopic protectomy and proctopexy codes 45395-45402; cholangiography/cholecystectomy codes 47560-47570; abdominal laparoscopy codes 49320-49325; renal laparoscopy codes 50541-50548; and hysteroscopy codes 58541-58554
Because of separate procedure defination in 45300, you use Modifier 59 when billed with colectomy procedures.
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on "sigmoidoscopy decompression volvulus and rectal tube placement?"
While there are new CPT codes for colonic stent placement, there are no specific codes for tube placement or the use of a guide wire in the colon.Your only option is to use unlisted-procedure code 44799 (unlisted procedure, intestine) to report the guide-wire. Whenever you use an unlisted code, you must include an operative report and a separate statement describing the steps taken in the guide wire procedure. This separate report should include the typical time taken to complete the procedure and mention a listed service that is its closest equivalent.
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on "payable icd9 codes for colonoscopy 45378 etc"
What Icd9 codes should be used to have Medicare pay for 45378 or 45380. We were denied payment for constipation 564.01 and for v12.79 hx of ulcerative colitis.
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on "payable icd9 codes for colonoscopy 45378 etc"
Please check with LCD list to see which Dx does it cover. 564.01 is not a compatible Dx
V12.79 Is an Unaccepted Principal Dx
There are numerous Dx which can be use used with 45378/45380
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on "Single ballon Enteroscopy w/ anesthesia"
Single Balloon Enteroscopy with anesthesia. Stuck in cpt code
43220 less than 30mm 43249 esophagus
Thank you
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on "Single ballon Enteroscopy w/ anesthesia"
ooops I used the wrong code. These are for something else Imeant to ask.44370 I do not find anything under Single balloon.
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