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 three questions that could be beneficial to your practice.
Question #1
We hold all our procedure claims until pathology is back, and then we are billing with those findings. We've never had an issue until recently. One of our carriers has denied multiple claims stating that two polyp codes can't be reported together. In the cases where patients have multiple polyps like the descending and sigmoid colon but per the ICD-10 book, the D12._ codes are excluded from K63.5.
Answer #1
Yes, only the D12._ (benign neoplasm, colon) should be reported and not the K63.5 (hyperplastic colon polyp) codes on the same line item since it is more significant and considered ICD-10 exclusions. You can add a comment to box 19 of the claim form that a hyperplastic polyp was also removed.
Question #2
Has there been a change to modifier 62 (co-surgery) being used when two gastroenterologists place a PEG tube endoscopically? My physicians used modifier 62 but the coders have indicated the physicians must be of different specialties. Please advise.
Answer #2
This depends on payer guidelines and what they allow for modifier 62 (co-surgery). Most Medicare contractors only allow modifier 62 to be used for two surgeons of different specialties, however, commercial payers may allow co-surgery for two providers of the same specialty. If you receive a denial or request for records, be sure to send both operative reports by each physician.
Question #3
Our physician is inquiring if a location to a biopsy can be added to the procedure report without it being an addendum? Should our software even allow it?
Answer #3
An addendum or late entry can be added for the biopsy location. Your software should not allow anything other than an addendum or late entry once the note has been signed. The date of the addendum has to be documented on the procedure note.