ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month, ASGE gets dozens of questions from members. 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
Under the new evaluation and management guidelines, it states that a minor surgery with risk factors is moderate risk. If we are doing an endoscopic workup on a patient, would this be considered minor surgery? If the patient has specific risk factors, does that need to be documented in the assessment/plan of care?
Answer
Endoscopy would be considered a minor surgery unless the provider specifically states it is a major surgery for a specific patient and why. Yes, the provider has to document patient-specific risk factors in the assessment/plan of care.
Question #2
Medicare announced that effective January 1, 2023, they will allow the beneficiary a screening colonoscopy after the patient has a positive Cologuard. Do you know the correct way to code these scenarios to Medicare?
Answer
To date, there is not clear guidance; however, we recommend assigning the screening primary ICD-10-CM diagnosis code Z12.11, followed by the positive Cologuard secondary ICD-10-CM diagnosis code R19.5. It is recommended to report CPT code G0121 if the procedure stays screening or the appropriate therapeutic CPT with modifier PT.