on "Single ballon Enteroscopy w/ anesthesia"

October 11, 2012, 9:31 am

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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 single balloon 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.

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on "EGD with removal of biliary stent CPT adn ICD-9"

October 11, 2012, 10:19 am

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One of our physician's performed an ERCP on a patient in the hospital and placed a biliary stent.
A month later, another physician removed the stent during an EGD via snare.
I am finding conflicting answers. Some say code for foreign body removal for both procedure and dx code. I also see where it is advised to code removal by snare with dx code as 'V58.49'. I appreciate your help!

on "EGD with removal of biliary stent CPT adn ICD-9"

October 11, 2012, 2:51 pm

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To bill ERCP with removal use (43269, Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent) your gastroenterologist must:

• perform an ERCP including the contrast imaging of the bile duct or pancreatic duct ,and/or

• replace the stent.

Use V53.99

on "Exploratory laparotomy reduction small bowel obstruction, wedge resection sm mas"

October 12, 2012, 4:55 am

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Dr did an exploratory laparotomy (49000) reduction of small bowel obstruction with release of adhesive band (44005) and wedge resection of small bowel mass at mid ileum w/out anastomosis.... suggestions for the wedge and the 49000 is bundled to the 44005?

on "EGD with removal of biliary stent CPT adn ICD-9"

October 12, 2012, 6:25 am

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So, how do i code the removal of the stent via EGD a month later? CPT and Diagnosis code?

Thanks

on "which code first v76.51 or v12.72"

October 12, 2012, 7:26 am

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If patient returns for personal history of polyps surveillance colonoscopy which diagnosis code is primary V76.51 or V12.72

on "which code first v76.51 or v12.72"

October 12, 2012, 10:59 am

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Screening colonoscopies will be performed on asymptomatic patients when they have attained the age for screening as a routine purpose. So you are right with using V76.51 (Special screening for malignant neoplasm, colon) as the primary diagnosis code when the first time the patient presents to your gastroenterologist and he decides to do a screening.

When your gastroenterologist records the patient's history and finds a family history of malignant neoplasm of the gastrointestinal tract or a personal history of malignant neoplasm of the large intestine, these findings should be recorded as secondary codes. So you will use V10.05 (Personal history of malignant neoplasm, large intestine), V12.72 (Personal history of colonic polyps) or V16.0 (Family history of malignant neoplasm, gastrointestinal tract) if your gastroenterologist records pertinent history in the documentation.

on "EGD with removal of biliary stent CPT adn ICD-9"

October 15, 2012, 3:47 pm

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43247-938

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on "Exploratory laparotomy reduction small bowel obstruction, wedge resection sm mas"

October 15, 2012, 5:16 pm

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49000 gets bundled into 44005
Use 49203-49205 for small bowel excision

on "Observations"

October 16, 2012, 12:19 pm

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When I coded 99218 my claims were paid then retracted. When I billed 99201, 99202, 99203, etc. my claims are denied if we have seen the patient in the last 3 years. What code is best when billing observation for an established patient when the ER doc has called a "consult" Is 99213 etc appropriate? If so what about HMO referrals? Bravo Insurance won't backdate referrals. Any help would be appreciated. Thank you.

on "Observations"

October 16, 2012, 1:35 pm

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Three main rules govern observation coding:

1. Report 99218-99220 with 99217 if the physician admits the patient to observation and releases her on a different date of service, unless the total duration of observation stay equals fewer than eight hours. For stays lasting multiple days, you may report one unit of 99218-99220 for each date of service (not counting the date on which the physician discharges the patient).

2. For stays of less than eight hours when the admission and discharge occur on different dates of service, report only 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient).

3. For observation stays that take place within a single date of service, you should report the observation/inpatient hospital care E/M codes 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date). You should not report a separate discharge code with 99234-99236.

In your case, the patient observation stay spans two dates of service but lasts only four hours total. Therefore, you should choose just the appropriate-level initial observation care code (99218-99220).

If the observation care had spanned two dates of service with a total duration of more than eight hours (for instance, the gastroenterologist admits the patient at 9 p.m. and discharges her the next day at 9 a.m.) you could report both the initial observation care (99218-99220) and the discharge service (99217, Observation care discharge day management).

In a third scenario, the gastroenterologist admits the patient at 9 p.m. on Thursday and does not discharge the patient until 9 a.m. on Saturday. In this example, you may report one unit of 99218-99220 for Thursday, one unit of 99218-99220 for Friday, and the discharge (99217) on Saturday.

Finally, consider the case in which the physician admits a patient at 6:00 a.m. and discharges her that day at 8 p.m. Because the admission and discharge occur on the same date, you should report 99234-99236 only.

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If the patient is in observation status in the hospital both days, admitted to observation by someone else, and you are asked to consult the first day and then you followed on your own the second day.

If this is a non-Medicare patient, the consult the first day is coded 99241-99245, and the visit the next day is coded 99224-99226.

If the patient has Medicare, then day one is coded 99201-99205 or 99211-99215, depending on whether you have seen this patient before, and day two is coded 99224-99226.

on "Pouch CPT Code"

October 16, 2012, 1:36 pm

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"Scope was introduced through the anus and advanced to the rectal pouch what cpt code would you use?"

I have the code for the stoma, but what code would you use for the above procedure?

on "Pouch CPT Code"

October 16, 2012, 1:58 pm

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45330-52 seems the code to describe the procedure. No Complete scopy to sigmoid , hence the use of 52 is appropriate.

on "Documenting Family History"

October 18, 2012, 12:01 pm

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Is it appropriate to document family history with this: Family history is not obtainable today due to language barrier (patient speaks only Spanish).

on "UNGROUPABLE DRG"

October 18, 2012, 2:09 pm

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Patient was admitted due to postoperative ileus-I have used 997.49 for this but when I tried to abstract a message claimed that this was ungroupable-should I have used 560.1 as principal dx and use 997.49 as secondary? This is very confusing-I appreciate any help!

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on "Documenting Family History"

October 18, 2012, 6:01 pm

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No, you cannot. There need to be a valid documented FHx. Coding needs a substantial documented FHx to code. A translator would be required to correctly decipher the patient's problem.

on "UNGROUPABLE DRG"

October 18, 2012, 6:19 pm

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An ileus commonly occurs following gastrointestinal surgery, and usually requires added treatment, nursing care and in some cases, an increase in the length of stay. Some coding professionals would argue that in checking the ICD-9-CM codebook index, you are lead to code 997.49, digestive system complications, and 560.1, paralytic ileus, when postoperative ileus is documented. This is true if you only code from the index, but ICD-9-CM coding rules require that you also check the tabular for accurate coding assignment. The tabular describes code 997.42, as other digestive system complications. It would appear that the physician would need to be queried for clarification as to whether the ileus is indeed a complication of the surgery. Let us refer back to The ICD-9-CM Official Guidelines for Coding and Reporting, Complications of Surgery and Other Medical Care, which by its title alone, tell us that the complication is due to the surgery or procedure. Most physicians do not consider an ileus occurring in the postoperative period to be a complication of the surgery, but rather an expected surgical outcome. When this is the case, only the ileus, 560.1, should be reported. Again, querying the physician for clarification is often needed for accurate code assignment.

http://californiahia.org/sites/californiahia.org/files/docs/CDQarticles/2012-02-coding-postop-complications.pdf

on "Fistulagram"

October 22, 2012, 7:49 am

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I need a cpt code for a fistulagram performed for the purposes to see if there is communication between the presacral space and the rectum. Patient had a presacral abscess that was previously drained, but a month later there was still to much fluid leaking.

on "Fistulagram"

October 22, 2012, 4:20 pm

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The proper code for this service is 49465 (Contrast injection[s] for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastrojejunostomy, or cecostomy [or other colonic] tube, from a percutaneous approach including image documentation and report).

This code does not have professional and technical components under the Medicare Physician Fee Schedule, so you should not append modifier 26 (Professional component) to report the physician's service.

You also should not add 76080 (Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation) because 49465 includes "image documentation and report."

on "Diagnosis for nonspecific colonoscopy findings"

October 23, 2012, 6:39 am

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What diagnosis code would you use based on the following:

Procedure:
Colonoscopy:
Multiple pedunculated polyps were found in the transverse colon and in the ascending colon consistent with inflammatory polyps. There was patchy erythema throughout colon, multiple random biopsies taken with cold forceps.

Pathology Results:
"Final Diagnosis:
A. RIGHT COLON, RANDOM ENDOSCOPIC BIOPSIES:
- FOCALLY POLYPOID FRAGMENTS OF COLONIC MUCOSA WITH NONSPECIFIC
CHANGES
B. LEFT COLON, RANDOM ENDOSCOPIC BIOPSIES:
- COLONIC MUCOSA WITHOUT DIAGNOSTIC ALTERATION"
Diagnosis comment on pathology report: "The specimens contain colonic mucosa with focal polypoid change in the right colon and areas of lymphoid aggregation in the right colon and rectosigmoid specimens. Mild lamina propria edema and chronic inflammation are identified, and the polypoid changes in the right colon specimen would be compatible with old inflammatory polyps. There is no evidence of malignancy or dysplasia and there is no histologic evidence of active inflammatory bowel disease."

The indication for the colonoscopy is "High risk colon cancer surveillance, ulcerative colitis".

What would the most appropriate dx be?