tci General Surgery Coding Alert - 2004 Issue 7

Reader Question: Sedation Codes Depend on Carrier

Question: A patient with severe upper abdominal pain reported to the office for an endoscopy. The surgeon induced conscious sedation with a 25-milligram injection of Demerol, inserted the endoscope and biopsied the patient's gastric mucosa. How should I code this visit?Arkansas Subscriber Answer: The correct answer depends on whether your insurer is a Medicare or a private payer.Medicare: If you are filing this claim with Medicare, report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) linked with 789.0x (Abdominal pain) for the endoscopy. Medicare...

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