tci General Surgery Coding Alert - 2008 Issue 6

You Can Report Multiple Endoscopies

If the surgeon performs another endoscopic procedure (for instance, 43239, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) during the same session as PEG tube placement (43246), you can bill for both procedures separately. Keep in mind that the multiple-endoscopy rule will apply. The payer will reimburse only the higher-valued procedure at 100 percent of the fee schedule amount. For the lesser-valued procedure, you will receive the standard fee schedule amount minus the value of the "base" endoscopic procedure -- in this case, 43235 (- diagnostic, with or...

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