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
When we bill an initial hospital consult for our first time seeing a patient in the hospital, we bill CPT codes 99251-99255. We are rarely the admitting physician. If the insurance no longer accepts the inpatient consult code set 99251-99255, and we are NOT the admitting physician, what code set should we be billing? Should that be the subsequent hospital codes 99231-99233 (even though it's our first time seeing the patient) or would it be the admitting physician initial consult code 99221-99223?
Answer
Per CMS guidelines, you would bill the initial inpatient visit codes, 99221-99223. For payers that don't accept consults, you can follow the same guidelines. However, we are seeing some of these payers deviate from CMS and pay only the admitting provider the initial inpatient visits and all specialists are left with subsequent inpatient visit codes (99231-99233). It is recommended that you check with all payers as to their policy(ies) and make all staff including providers, billers and coders aware of any changes.
Question #2
What CPT code would you use for EGD with Maloney in the endoscopy center?
Answer
The Maloney dilator is the most commonly used bougie dilator. Made of rubber and filled with mercury or tungsten, it has a tapered tip and is freely passed without a guidewire so CPT code 43450 (dilation of esophagus, by unguided sound or bougie, single or multiple passes) would be appropriate as well as CPT code 43235 for the EGD when done for diagnostic purposes. No modifiers are required.