Thursday, June 23, 2016

Coding Guidelines for Endoscopy Part 1 - Diagnostic Enodoscopy and Multiple Endoscopies

Surgical vs. Diagnostic Endoscopy
AMA guidelines indicate that a diagnostic endoscopy is an integral part of a surgical endoscopy and should not be billed separately. CCI instructions agree stating “surgical endoscopy includes diagnostic endoscopy. A diagnostic endoscopy HCPCS/CPT code should not be reported with a surgical endoscopy code.”

Multiple Endoscopies

When multiple endoscopic procedures are performed, providers should report the most comprehensive code describing the services according to both AMA and CCI
guidelines. If multiple services are performed and not adequately described by a single HCPCS/CPT code, more than one code may be reported. Multiple procedure
modifier 51 should be appended to the secondary HCPCS/CPT code. Only medically necessary services may be reported. Incidental examination of other areas should
not be reported separately.

When more than one endoscopy is performed during the same operative session, report only the most extensive services.

Biopsies, Brushing and Washings

Brushings and washings are considered an integral part of a diagnostic endoscopy and therefore should not be reported separately.

When multiple biopsies are obtained, report the appropriate surgical endoscopy code only once, regardless of the number of specimens obtained.

It is appropriate, however, to report both a biopsy and an excision code when two separate sites are involved. If a biopsy is performed on the same lesion that was removed, it is separately reportable only when the biopsy is utilized for immediate pathologic diagnosis prior to the more extensive procedure, and the decision to proceed with the more extensive procedure is based on the results of the pathologic examination. Modifier 58 should be appended to indicate that the biopsy and excision procedure were planned or staged procedures. If however, the results of the biopsy are not reported until after the removal, the biopsy should not be reported separately.

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