ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are three questions that could be beneficial to your practice.
Question #1
We have an office visit prior to a colonoscopy for surveillance for colostomy reversal. Our provider does not manage patients' anticoagulants, however, he did order the patient to stop Coumadin, five days prior to the procedure. Would this count as a moderate level for prescription management?
Answer #1
If the provider is not managing the prescription, then it would be recommended to not count this under moderate risk for prescription drug management.
Question #2
We billed a colonoscopy, 45378-33 for a patient's first-time screening colonoscopy and it came back denied for medical necessity. We used the diagnosis of Z12.11. Do you know what we did wrong or do you have any other recommendations on how this could have been billed differently?
Answer #2
This depends upon the payer/plan for preventive services for screening colonoscopy. Many commercial payers recognize the G-codes for screening colonoscopy (G0121 for average risk and G0105 for high risk). It would be recommended to resubmit a claim with G0121 and Z12.11.
Question #3
I am wondering if I can bill both 43248 (EGD w/ guidewire dilation) and 43450 (unguided dilation) for this EGD. Indications are GERD, Esophageal Dysphagia and Eosinophilic esophagitis.
Complete EGD: The endoscope was introduced through the mouth and advanced to the second part of the duodenum.
Findings: Esophagus-Severe EOE with concentric rings, vertical (linear) furrows of the mucosa with no bleeding and white exudates in the esophagus. Cold forceps biopsies were performed for histology. Initially could not pass scope beyond the proximal esophagus. Had to dilate with Maloney in order to pass the upper scope. Biopsies were obtained for research study, then pass Savary - Gilliard wire and redilated to 11 and 12 mm. Normal stomach and Normal duodenum.
Answer #3
You would bill the most extensive dilation done not both, so it would be recommended to bill 43248.