Archive for the ‘gastroenterology’ Category
Reading 44373’s code descriptor is key to getting your G Tube claim right.
Question: The gastroenterologist goes to the hospital to treat a patient that had recently been admitted because his gastrojejunostomy tube had migrated to his stomach. After performing a problem focused interval history and exam, the gastroenterologist decides to perform an EGD to reposition the tube. I cannot find a code for repositioning a G tube; how should I code this scenario?
Answer: Judging by your encounter description, the patient’s percutaneous jejunostomy tube (J tube) slipped and became a percutaneous gastrostomy tube (G tube). On the claim, report the following:
- 44373 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneousgastrostomy tube to a percutaneous jejunostomy tube) for the EGD;
- 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity …) for the E/M;
- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99231 to show that the E/M and tube fix were separate services; and
- 536.42 (Disorders of function of stomach; gastrostomy complications; mechanical complication of gastrostomy) appended to 44373 and 99231 to represent the patient’s condition.
Explanation: The descriptor for 44373 might be a bit misleading, but it mentions only “tube conversion.” The tube does not necessarily have to be new.
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Posted by suzanne.leder on February 7, 2010 at 7:25 pm under 44373, 99231, Coding Challenge, E/M, EGD, G tube, gastroenterology, modifier 25, tube conversion.
Tags: Complexity, Conversion, Decision Making, Descriptor, Duodenum, EGD, Encounter, Enteroscopy, Gastroenterologist, Gastrojejunostomy Tube, Hero, Interval History, Jejunostomy Tube, Management Service, Medical Decision, modifier 25, Percutaneous Gastrostomy, Repositioning, Right Question, Stomach
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Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient pre-screening a separate E/M?
Answer: Do not report a separate E/M for this encounter. On the claim, report 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 service.
Explanation …
When a patient reports to the gastroenterologist for a scheduled procedure, the pre-service time is almost always included in the procedure code. It does not matter if the patient has been to your practice before.
There are exceptions to this rule, but an allowed E/M service before a scheduled diagnostic colonoscopy is rare, and judging by the details of your description, this precolonoscopy service would be rolled into 45378.
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Posted by Editor on February 3, 2010 at 9:25 pm under 45378, Coding Challenge, E/M, colonscopy, gastroenterology.
Tags: ABN, Colon, Colonoscopy, Decompression, Education, Encounter, Exceptions, Family Physician, Free Sample, Gastroenterologist, Local Family, M Service, Patient Questions, Placements, Pre Service, Related Articles, Service Time, Specimen, Virtual Colonoscopy
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Coding Hint: Watch for ‘add-ons’ during Remicade sessions
Question: An established patient with a plan of care in place for his Crohn’s disease of the ileum reports to the gastroenterologist for a Remicade infusion. The infusion started at 10:00 a.m. and ended at 11:42. The patient reported nausea during the infusion, so the gastroenterologist administered 200 mg of Benadryl from 10:41 to 10:52. How should I report this encounter?
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Answer: This claim has a lot of moving parts; you can code for both the Remicade and the Benadryl administrations. Because your Benadryl infusion time was so short, however, you should not report an infusion code for that service.
Follow this two-step guidance on how to ethically maximize this claim:
Step 1 — Remicade: The total infusion time for the Remicade treatment was an hour and 42 minutes. Represent this time with the following:
• 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour
• +96415 (… each additional hour [List separately in addition to code for primary procedure]) for the remaining 42 minutes
• 555.0 (Regional enteritis; small intestine) linked to 96413 and +96415 to represent the patient’s condition
• J1745 (Injection, infliximab, 10 mg) x 20 for the supply of Remicade.
Step 2 — Benadryl: Payers will allow separate codes for any antiemetics the gastroenterologist provides during Remicade infusions. Since the Benadryl infusion took less than 15 minutes, however, you should consider it a push and report +96375 (Therapeutic, prophylactic, ordiagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]) with 555.0 attached. Also, report J1200 (Injection, diphenhydramine HCl, up to 50 mg) for the Benadryl supply.
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Posted by Editor on November 9, 2009 at 11:00 pm under +96415, 555.0, 96375, 96413, Benadryl, Chron's, Coding Challenge, J1200, J1745, Remicade, gastroenterology, infusion.
Tags: Antiemetics, Benadryl, Chemotherapy, Crohn S Disease, Diphenhydramine, Gastroenterologist, Infliximab, Infusion Technique, Infusions, Intravenous Infusion, Moving Parts, Nausea, Prophylactic, Remicade, Remicade Infusion, Remicade Treatment, Small Intestine, Step 1, Step 2, Step Guidance
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Question: Notes indicate that the gastroenterologist performs a rigid sigmoidoscopy; during the encounter, he also performs an anoscopy without anesthesia and three biopsies of the mucous membrane. How should I report this episode? Can I report the exam separately with 46600?
Answer: You can report a single code for these three services. On the claim, report 45305 (Proctosigmodoscopy, rigid; with biopsy, single or multiple) for the sigmoidoscopy, the anorectal exam, and the three biopsies.
Why: When the gastroenterologist performs an anoscopy (46600 [Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or mucous membrane biopsy during a sigmoidoscopy, the services are bundled into 45305.
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Posted by Editor on October 13, 2009 at 7:38 am under 45305, 46600, Coding Challenge, anoscopy, biopsy, gastroenterology, sigmoidoscopy.
Tags: Amp, Anesthesia, anoscopy, Biopsies, biopsy, Code Question, Coding Clinic, Compliance, Encounter, Endoscopy, Fulguration, Gastroenterologist, Mistake, Mucous Membrane, Punch, Related Articles, Rigid Sigmoidoscopy, Specimen, Tonsil, Urology Practice
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Reading 44373’s code descriptor is key to getting your G Tube claim right.
