Gastroenterology coding: 43255 and control-of-bleeding situations
Coding for excessive blood loss? If so, modifier 22 may not be the ally you are looking for. Your answer may lie on more spot on CPTs such as 43255 and critical care codes.
In the first scenario, the doctor injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy (43239). Earlier, you may opt to use 43239 added with modifier 22 if the physician required significant effort to control the patient's bleeding.
However this option would need you to submit additional paper documentation to support your modifier 22 claim. So instead if submitting yourself to potential hassles, you can correctly describe this session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.
As is obvious from 43255's descriptor, this procedure describes control of bleeding by “any method," including injection.
Necessity: On your claim, you should add modifier 59 to 43255, and then report 43239. If you leave out the modifier, it would give payers the impression that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.
In the second scenario, when the gastroenterologist is about to carry out an upper GI endoscopy, the patient undergoes very severe gastrointestinal bleeding; so much so that the physician must suspend the endoscopy and spend 40 minutes lavaging blood from the gastro-intestinal tract before continuing.
Report it: This time round, the critical care code 99291 is your best choice.
Here's why: if the gastroenterologist caused the bleeding, you can't bill for the control of bleeding procedure. You should ask control-of-bleeding codes only when treatment is required to control bleeding that takes place spontaneously or as a consequence of traumatic injury (noniatrogenic), and not as a consequence of another type of operative intervention.
You should bear in mind that the time spent at the bedside carrying out services including lavage of gastric blood isn't included in the performance of a subsequent endoscopic procedure and isn't part of the evaluation & management service that might be carried out on the same day.
Nonetheless, you should not report a critical care code carelessly for an excessive bleeding situation that is not out of the ordinary. Extra time for emergency bedside services less than 30 minutes does not count as billable critical care service. For prolonged critical care services, the doctor should exclusively note the amount of time in his notes.
Coding for excessive blood loss? If so, modifier 22 may not be the ally you are looking for. Your answer may lie on more spot on CPTs such as 43255 and critical care codes.
In the first scenario, the doctor injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy (43239). Earlier, you may opt to use 43239 added with modifier 22 if the physician required significant effort to control the patient's bleeding.
However this option would need you to submit additional paper documentation to support your modifier 22 claim. So instead if submitting yourself to potential hassles, you can correctly describe this session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.
As is obvious from 43255's descriptor, this procedure describes control of bleeding by “any method," including injection.
Necessity: On your claim, you should add modifier 59 to 43255, and then report 43239. If you leave out the modifier, it would give payers the impression that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.
In the second scenario, when the gastroenterologist is about to carry out an upper GI endoscopy, the patient undergoes very severe gastrointestinal bleeding; so much so that the physician must suspend the endoscopy and spend 40 minutes lavaging blood from the gastro-intestinal tract before continuing.
Report it: This time round, the critical care code 99291 is your best choice.
Here's why: if the gastroenterologist caused the bleeding, you can't bill for the control of bleeding procedure. You should ask control-of-bleeding codes only when treatment is required to control bleeding that takes place spontaneously or as a consequence of traumatic injury (noniatrogenic), and not as a consequence of another type of operative intervention.
You should bear in mind that the time spent at the bedside carrying out services including lavage of gastric blood isn't included in the performance of a subsequent endoscopic procedure and isn't part of the evaluation & management service that might be carried out on the same day.
Nonetheless, you should not report a critical care code carelessly for an excessive bleeding situation that is not out of the ordinary. Extra time for emergency bedside services less than 30 minutes does not count as billable critical care service. For prolonged critical care services, the doctor should exclusively note the amount of time in his notes.
