CatcCatch These Tips for Coding Endoscopies With Control of Bleedingh These Tips for Coding Endoscopies With Control of Bleeding

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Catch These Tips for Coding Endoscopies With Control of Bleeding

By Susan Dooley

Gastroenterologists have been using endo clips, also called hemoclips, to close wounds and attain

hemostasis during endoscopy procedures for more than 20 years. GI endoscopists find these small metal

devices to be effective to close wounds and stop bleeding in conditions such as ulcers, Mallory-Weiss

tears, bleeding diverticula, arteriovenous malformations, and bleeding polypectomy sites. To use endo

clips, physicians place the clip at the GI tract bleeding site using an endoscope. Once the bleeding stops

and the mucosa heals, endo clips spontaneously detach, passing out of the body undetected in the

stool. Gastroenterologists use endo clips during endoscopic procedures like colonoscopies,

sigmoidoscopies, and esophagogastroduodenoscopies.

Get a Clue for Coding With Clips

Codes don’t specify use of hemo clips, but since gastroenterologists often use these devices to control

bleeding, their mention in an endoscopy report clues you that you need to report an endoscopy code

that includes hemostasis.

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Here’s a handy list of procedure codes for endoscopy with control of bleeding. Make sure you note the

location of the clip placement to choose the right code.

Esophagoscopy:

43227, Esophagoscopy, flexible, transoral; with control of bleeding, any method

Esophagogastroduodenoscopy:

43255, Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method

Enteroscopy:

44366, Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including

ileum; with control of bleeding (eg, injection … )

44378, Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum;

with control of bleeding (eg, injection …)

Sigmoidoscopy:

45317, Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar

cautery, laser, heater probe, stapler, plasma coagulator)

45334, Sigmoidoscopy, flexible; with control of bleeding, any method

Colonoscopy:

44391, Colonoscopy through stoma; with control of bleeding, any method

45382, Colonoscopy, flexible; with control of bleeding, any method.

Review This Documentation Sample

A gastroenterologist performed a video esophagogastroduodenoscopy with small bowel enteroscopy,

obtaining biopsies and stopping bleeding using an endo clip and bipolar cautery. The patient had a 2 mm

bleeding arteriovenous malformation (AVM) in the distal duodenum, with bleeding controlled with

electrocautery and clip application. Also, the patient had a 1 mm AVM in the distal esophagus, the

bleeding of which was controlled with electrocautery.

What do you report? In this case, though the gastroenterologist used both modalities for hemostasis in

the bleeding AVMs located in both the esophagus and the duodenum, report only one code: 43255

(Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method).

How’s Your Endoscopy Coding Working?

Have you run into any pitfalls with your payers when coding endoscopies with endo clip applications?

How did you resolve them?




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CatcCatch These Tips for Coding Endoscopies With Control of Bleedingh These Tips for Coding Endoscopies With Control of Bleeding