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FAQs: Frequently Asked Questions from the ASGE Coding Questions Center

Colonoscopy

Q. The coding department of the hospital where we perform our procedures has contacted our office challenging our ICD-9 coding for procedures that were originally scheduled as screening colonoscopies, but were coded with 211.3 (benign neoplasm of colon) when a polyp was identified and removed. It is the opinion of the hospital coders, based on information they received from the American Hospital Association's (AHA) Coding Clinic that, for diagnostic procedures, the primary diagnosis should always be the screening (V76.51) even when a polyp is identified and removed. It is our understanding that the primary diagnosis should be the polyp, not the screening. Who is right?

Q. If the physician does a colonoscopy with snare excision of polyps and a cautery polypectomy of another, can we charge for two polyps??

Q. The physician did a colonoscopy with removal of multiple polyps. Can we charge for all of them??

Q. What code do we use for removal of a polyp with cold forceps??


UGI Endoscopy

Q. How do we bill for EGD with Botox injection?

Q. When we are billing two procedures for example, colonoscopy and EGD performed on the same day/same setting, we are being denied the second procedure. What should we do?

Q. The physician performs an EGD in the morning and a colonoscopy in the afternoon, because the physician could not identify the bleeder with the EGD. Would I use modifier -50 in this situation??

Q. What is the appropriate code to use for EGD with decompression??

Q. Can we charge for two physicians doing a PEG placement? One was a surgeon and the other a gastroenterologist.?

Q. What code do we use to convert a PEG tube to a J tube??

Q. When we do fluoroscopy to guide a complex endoscopic dilation, we have always been paid, but recently I got a denial saying that someone else had already billed for this (the radiologist). Can we still bill for fluoroscopy with a modifier -26 or is this something new with Medicare?

Q. What code do I use for insertion of a feeding tube??

Q. What code do I use for removal of a G-tube?

Q. Can we charge for removal of a gastrostomy tube in the office??

Q. The doctor performed an EGD with a Maloney dilator and a balloon dilator. Can I code for both?


ERCP

Q. How do I bill for ERCP with sphincterotomy after which I did a balloon dilation of biliary duct?

Q. If the physician does an ERCP with stent placement, what code should I use??


E&M

Q. The physician did a new consult and procedure on the same day. Do we use the -57 modifier on the E/M code??

Q. What is a consult vs. new patient??


Miscellaneous

Q. With regard to code 82270, how many times can that be billed for the number of cards given to and received from a Medicare patient??

Q. How do I code for endoscopy to mark the intestine with India dye in preparation for surgery??

Disclaimer
The American Society for Gastrointestinal Endoscopy (ASGE) has made reasonable efforts to confirm the accuracy of the information provided but this advice is intended only to provide a broad overview of coding and coverage. The information is not intended to serve as specific advice about how to utilize, code, bill or charge for any medical product or services. Clinical scenarios, non-clinical circumstances, individual payer policies and numerous other factors may impact a particular situation. ASGE makes no representation or warranty regarding the completeness or accuracy of the information.