ENDOSCOPY PROCEDURES:
A. Esophagoscopy (43191 – 43232)
B. Esophagogastroduodenoscopy
(43235 – 43210)
C. Esophagus to
Jejunum (44360 – 44373)
D. Esophagus to
ileum (44376 – 44379)
E. Ileoscopy
through a stoma (44380 - 44384)
F. Colonoscopy
through a stoma (44388 - 44408)
G. Proctosigmoidoscopy
(45300 – 45327)
H. Sigmoidoscopy (45330 – 45347)
I. Colonoscopy
(45378 – 45398)
J. Anoscopy (46600
– 46615)
Esophagoscopy – Visualization of the esophagus via a
thin tube-like instrument (Rigid type or Flexible type).
Examination of
cricopharyngeus muscle to the Gastroesophageal junction it may also include a
proximal region of the stomach.
The instrument
is inserted via oral (Transoral) or via the nose (Transnasal).
CPT codes: 43191 - 43232
Esophagogastroduodenoscopy – Visualization of the esophagus, stomach and duodenum. A
flexible instrument inserted via Transoral.
If the duodenum
is deliberately not examined then append modifier 52 /53 based on repeat exam
is planned or not.
A. No repeat exam is planned – append
modifier 52
B. Repeat exam is planned – append modifier
53
CPT codes: 43235 – 43210
Small Intestine (Enteroscopy) Endoscopy –
1. Antegrade Transoral –
A. Esophagus to Jejunum (44360 –
44373)
B. Esophagus to ileum (44376 – 44379)
2. Retrograde via Anal/colon stoma – 44799
(Unlisted)
Note: If an endoscope can’t be advanced at least 50 cm beyond the
pylorus – Code as Esophagogastroduodenoscopy.
Stomal, Endoscopy - Examination of the intestine via the stoma.
1. Ileoscopy through a stoma (44380
- 44384)
2. Colonoscopy through a stoma (44388
- 44408)
Proctosigmoidoscopy – Examination of the rectum and may include the examination of
a portion of the sigmoid colon.
CPT codes: 45300 - 45327
Sigmoidoscopy – Examination of the rectum and sigmoid colon and may include the
examination of a portion of the descending colon.
CPT codes: 45330 - 45347
Colonoscopy – Examination of the entire colon (Rectum to Cecum) may include the
examination of the terminal ileum.
CPT codes: 45378 - 45398
1. Modifier 53: If a patient is
scheduled for diagnostic / screening colonoscopy but the physician is unable to
advance the scope to the Cecum.
2. Modifier 52: If a patient
is scheduled for a therapeutic colonoscopy but the physician is unable to advance
the scope to the Cecum.
Anoscopy (46600 – 46615) – Examination of the Anus
ENDOSCOPY PROCEDURES - General Coding Guidelines:
1. Procedures like venous access, infusion and injection, non-invasive oximetry, anesthesia provided during endoscopy procedures are considered as part of the procedure.
2. If the same therapeutic endoscopy procedure is performed repeatedly in the same area, Bill the service once. If different therapeutic procedures are performed multiples endoscopy codes can be used accordingly.
3. Diagnostic endoscopy is always included in the therapeutic endoscopy.
4. When the small intestine endoscopy CPT ranges from 44360 - 44386 is performed as part of another major procedure then endoscopy is considered as part of the procedure, hence should not be billed separately along with more extensive procedures like enterostomy etc.
5. When diagnostic endoscopy of the hepatic/ biliary/pancreatic system using separate approach is performed – append modifier 51.
6. When a biopsy is performed and followed by excision/ destruction/removal of the biopsied lesion, then the biopsy is considered as part of the procedure should not be billed separately.
7. Bleeding occurs as a result of endoscopic procedure and control of bleeding in the same session of other major endoscopy procedure is considered as part of the procedure. If the bleeding control is performed in separate sessions following endoscopy procedure append modifier 78 (Postoperative return to the operating room following the related procedure)
8. When sigmoidoscopy is performed along with colonoscopy in the same session, code only the colonoscopy.
9. When a sigmoidoscopy and colonoscopy is performed as part of another major procedure then these services are considered as part of the procedure should not be billed separately. Eg: colectomy procedure.
10. If the larynx is viewed using esophagoscope, don’t bill laryngoscope separately.
ERCP – Endoscopic retrograde cholangiopancreatography
- ERCP is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to
diagnose and/or treat problems of the bile and pancreatic ducts.
1. An ERCP is considered complete if one or
more of the ductal system (biliary/pancreas) is visualized.
2. If ERCP is attempted but with
unsuccessful cannulation of any ductal system, - report
Esophagogastroduodenoscopy procedure codes.
3. For reporting purposes:
Pancreas: Major
and minor ducts
Biliary tree:
Common bile duct, right hepatic duct, left hepatic duct, cystic duct.
4. ERCP with stent placement includes
balloon dilation in that duct.
5. ERCP with more than one stent placement
(Different duct or side by side in the same duct) - report CPT 43274 more than
once with modifier 59.
6. ERCP with multiple stent exchange –
report 43276 more than once with mod 59.
7. ERCP with balloon dilation of multiple
ducts reported with modifier 59
8. Sphincteroplasty or dilation of the
ductal stricture is required before proceeding to remove the stone from the
duct during the same session may be reported separately. Note: Dilation
that is incidental to the passage of an instrument to clear stone is included.
9. Stone destruction includes stone removal
in the same ductal system.
Allotransplantation Procedures:
Any organ transplantation, there are three distinct
components,
A. Donor – Cadaver or Living
- Harvesting organ and cold preservation.
B. Backbench work
- Standard
preparation prior to transplant.
C. Recipient allotransplantation with or
without recipient organ removal.
- Transplantation
of allograft and care of the recipient.
Percutaneous Biliary Procedures:
- Transhepatic
- Transcholecystic
Drainage
catheter:
A. External biliary drainage
B. Internal and External biliary drainage
C. Internal biliary drainage (Stent)
External – Catheter placed into a bile duct to drain only externally.
Internal and External – Two-way catheter (Catheter terminates in the
small intestine to drain internally as well as externally).
Internal Stent: Percutaneously placed device drains internally.
Stent codes (47538, 47539, 47540) – reported only once if,
- One or more
overlapping or serial stents placed within a single duct
- Bridging
more than one ductal segment via single access.
Stent codes (47538, 47539, 47540) – Coded more than once with Mod
59
- Side by
side (Double barrel) within a single duct.
- Two or more
stents into the separate bile duct.
- Two or more
separate access.
Diagnostic
Cholangiography (47531 and 47532) is included with percutaneous biliary
procedures.
Balloon
dilation (47542) is included in stent placement codes.
Incidental
removal of debris is included in catheter /stent placement codes.
Balloon
dilation (47542) is included in the removal of calculi or debris (47544).
Biliary endoscopy, percutaneous via T-tube (47552- 47556)
Hernioplasty, Herniorrhaphy, Herniotomy:
Hernia repair codes are based on;
- Type of a
hernia (Inguinal, femoral, Incisional etc)
- Initial or
recurrent.
- Reducible
or incarcerated/strangulated.
Post-conception age: Age at birth plus age at the time of operation.
- (Preterm –
25 weeks at birth plus age 15 weeks at the time of operation = 40
weeks)
The
excision/repair of strangulated organs such as testicle,
intestine, ovaries are reported by using the appropriate code in
addition with hernia repair codes.
Don’t code CPT
49568 (mesh or other prostheses) along with hernia repair
codes except for Incisional hernia repair codes (49560-49566)
Codes 49491 –
49451 are unilateral procedures – append modifier 50 for bilateral procedures.
For reduction
and repair of an intra-abdominal hernia – CPT 44050
Omphalocele: Birth defect intestine or abdominal organs are outside of
the body because of a hole in the belly button.
A. Small – small portion of the intestine
outside the body
B. Large – Involving organs like liver,
spleen and intestine.
Gastrostomy / Duodenostomy / Jejunostomy / Colonic tube
Nasogastric
tube (or) Orogastric tube is included.
The codes are based on,
A. Initial placement (49440 - 49442)
B. Conversion (49446)
C. Replacement (49450 - 49452)
D. Removal of obstructive material (49460)
E. Checking the tube (49465)
Note: If an existing tube is removed and a new tube is placed
via separate access – Not considered as a replacement, code
as Initial placement codes.
Endoscopic placement of percutaneous Gastrostomy tube – CPT
43246
Change of Gastrostomy tube, percutaneous, without imaging or
endoscopic guidance – CPT 43760
Placement of
Enterostomy / Cecostomy tube, open – CPT 44300
Laparoscopy Procedures:
- Minimally
invasive surgery, a fibre-optic instrument is inserted
through a small incision made in the abdomen wall to examine or operate on the
interior of the abdominal or pelvic cavities.
Surgical
laparoscopy always includes Diagnostic laparoscopy.
Bariatric Surgery:
- Weight
loss is achieved by reducing the size of the stomach with a gastric
band or through the removal of a portion of the stomach
(sleeve Gastrectomy or biliopancreatic diversion with duodenal switch) or
by resecting and re-routing the small intestines to a small
stomach pouch (gastric bypass surgery).
Hemorrhoids / Piles:
- Swollen and
inflamed veins in the rectum and anus that cause discomfort and bleeding.
A. Internal hemorrhoids
B. External hemorrhoids
Don’t report
Anoscopy (46600) along with hemorrhoids procedures.