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Hint: Mind your modifiers to ensure accurate coding and compliance.

Gastroenterologists and other physicians often perform endoscopies because of the procedures鈥� versatility. They serve not only as a tool for disease screening, but also for the diagnosis and treatment of numerous conditions and complications.

Colonoscopy and esophagogastroduodenoscopy (EGD) are two types of endoscopies that providers frequently use to examine the gastrointestinal (GI) system. When performed as a follow-up on the same date of service (DOS) as other procedures, coding can prove challenging.

Read on to learn how to correctly code multiple endoscopies on the same DOS.

Understand When Multiple Endoscopies Are Necessary

Multiple endoscopies may be required on the same day or follow-ups may be necessary for other types of procedures. Repeat studies may be needed if the first was insufficient, more extensive workup may be required, or complications from the original procedure may require a return to the operating room (OR) to be treated. The key to accurately reporting follow-up endoscopies is the utilization and correct application of modifiers.

Modifiers help paint a picture of why multiple procedures were necessary. Depending on the type of endoscopy, the global period may be 0 to 90 days, so any follow-up and return to the OR will require a modifier. Other considerations, such as the place of service, the providers performing the procedures, bundling edits, and Medically Unlikely Edits (MUEs), can also influence coding. The five scenarios outlined below illustrate examples and offer guidance to help coders navigate the complexities of reporting same-day follow-up endoscopies.

Examine the Following Scenarios

Scenario 1: A patient presents with symptoms concerning for malignancy and undergoes a diagnostic colonoscopy in the morning. There was inadequate visualization secondary to poor prep and the procedure was discontinued. The patient was brought back in the afternoon after additional prep and the physician performed a complete diagnostic colonoscopy successfully.

The morning colonoscopy would be reported as 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed). Append modifier 53 (Discontinued procedure) to reflect that the procedure was discontinued. The second colonoscopy in the afternoon would also be reported with 45378, this time appending modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to indicate that the same physician repeated the procedure.

Scenario 2: A patient presents to the emergency department (ED) with throat pain and trouble swallowing. The ED provider performs a diagnostic EGD and notes what appears to be chicken or fish bones obstructing the esophagus. The GI service is consulted, admits the patient, and takes them to the OR for another EGD to remove the foreign material.

The diagnostic EGD and foreign body removal are bundled procedures. When performed by the same provider during the same session, the diagnostic EGD would not be separately reportable. Since these services were performed by two providers in distinct places of service, both can be billed. You鈥檒l report the diagnostic EGD for the ED provider and report 43247 (Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)) for the GI provider. A modifier to override any bundling edits is not generally required since the providers are not practicing within the same specialty but always be sure to verify any specific payer requirements.

Scenario 3: A patient presents for a colonoscopy with endoscopic mucosal resection. Later that day, the patient begins to experience pain and hemorrhaging. The patient is returned to the operating room where a second colonoscopy is completed to control the bleeding.

Report the first colonoscopy with 45390 (Colonoscopy, flexible; with endoscopic mucosal resection). Since a return to the operating room was required, you鈥檒l report the second procedure as 45382 (Colonoscopy, flexible; with control of bleeding, any method), and you鈥檒l append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period). Had the control of bleeding occurred during the same session as the mucosal resection, it would not be separately reportable since coding guidelines advise that control of bleeding is an inherent part of the procedure.

Scenario 4: A patient who has just undergone laparoscopic hiatal hernia repair experiences severe postoperative pain. The provider returns the patient to the OR the same day and performs a follow-up diagnostic EGD to assess for any complications.

Report the hernia repair with 43281 (Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh). Assign 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) to report the follow-up EGD. The return to the operating room for the EGD is unplanned but related to the hernia repair surgery, so modifier 78 would be appended to 43235.

Scenario 5: A patient undergoes endoscopy after experiencing multiple gastrointestinal symptoms. The provider performs a diagnostic EGD and no significant findings were noted. The decision was made then made to also complete a diagnostic colonoscopy for a more thorough examination.

Coders would report the colonoscopy with 45378. You鈥檒l then report the EGD with 43235. Some payers may require that modifier 51 (Multiple procedures) be appended to the lower relative value unit (RVU) procedure, which in this case is the EGD, to indicate multiple procedures were performed during the same session. These codes do have a separate procedure designation, however, and modifier 59 (Distinct procedural service) would not be needed since it is clear that the procedures were not in the same area.

Pay Attention to the Situation鈥檚 Complexity

Endoscopies are invaluable tools in modern medicine, allowing for diagnosis, treatment, and follow-up care of a variety of conditions and complications. When endoscopic procedures are performed as a follow-up on the same day, accurate coding and modifier application become crucial to reflect the complexity of the situation. Correct application of modifiers plays a key role in ensuring that procedures are reported properly.

The scenarios discussed highlight the nuances involved in coding these procedures. By following these guidelines, coders can navigate the challenges of same-day follow-up endoscopies with confidence.

Brittany Sowards, BA, CPC, CPMA, CCC, CCVTC, Clinical Documentation Specialist