ASGE members may submit coding inquiries electronically to codingquestions@asge.org. 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 two questions that could be beneficial to your practice.

Question #1

A patient came in for a surveillance colonoscopy for a history of polyps. However, during the procedure, the doctor took random biopsy samples due to the patient’s history of Crohn’s disease. Can I bill it as diagnosis codes Z86.010 and K50.90? Or do I have to bill it as just diagnosis code K50.90?

Answer

There is really no such thing as a history of Crohn's disease since it never is cured, so Crohn's disease is the indication. If biopsy samples of abnormal tissue were taken, this could be billed as surveillance with both Crohn's disease and the history of polyps. However, if random biopsy samples of normal tissue were taken, this would be diagnostic.

Question #2

I have a question regarding medical decision-making. I have a new provider asking for clarification on what is considered an "independent interpretation of tests." Other than what is listed in the CPT guidelines, do you have any specific examples I can share with the provider?

Answer

An example would be if the provider independently reviewed and interpreted radiology films as opposed to reviewing a radiologist’s report. The provider would need to state that they personally reviewed the images which showed ____________.