Endoscopy What is it and how is it coded?

Endoscopy Anything ending with the suffix “–scopy” means viewing or looking, with a special tool. This of a microscope or a periscope. Endo means “inside.” So, Endoscopy means looking inside using a tool, called an “Endoscope.”

Flexible Endoscope The endoscope is basically a camera in a tube which can be inserted into body cavities or organs. Image credit: Wikimedia Commons, permission granted to distribute or modify under GNU free documentation license.

Common Endoscopic Procedures Endoscopic procedures are performed by inserting the endoscope into the body through an existing orifice or a small surgical opening. An endoscopy is coded to the full extent of the area visualized. So code for farthest spot the scope reached and visualized.

Diagnostic Vs. Surgical Endoscopy Diagnostic endoscopies are generally for observation and viewing only. They look but do not cut, or treat. Surgical endoscopies, however, involve viewing and then either performing a surgical operation or taking a biopsy specimen. NEVER code a diagnostic endoscopy when a surgical biopsy was performed, even if the diagnostic endoscopy was the planned procedure. Diagnostic endoscopies are BUNDLED (packaged) into the surgical endoscopy procedure, so bill surgical endoscopy when both are performed!

Examples of Endoscopies An “upper GI (gastro-intestinal)” endoscopy often takes its name from the area(s) it views. Esophagoscopy views the esophagus without crossing the pylorum ( ). Esophagogastroduodenoscopy (almost always abbreviated: EGD) crosses the pylorum and views the esophagus, stomach and duodenum ( ). Do not code for separate areas viewed along the way, the single code from the origin (mouth) to destination (duodenum) is the EGD.

Point of Entry Most endoscopies involve insertion of a camera through an existing opening, such as the nose, mouth, ear, urethra, anus, tracheostomy (a surgical opening in the trachea), colostomy (a surgical opening in the colon). However, for some endoscopies, a small incision is made for insertion of the scope.

Endoscopies involving an Incision Arthroscopy (arthro- joint) views the inside of a joint, such as a knee, using a very small incision to insert the scope. Laparoscopy (laparo- abdomen) or thoracoscopy (thoraco- thorax) view the inside of the chest or abdomen through a small incision. Many surgeries may now be performed laparoscopically (with a scope and a tiny scope-sized incision) rather than using a wide-open abdominal incision. Recovery times are much shorter for laparoscopic procedures because the incision is so much smaller.

Laparoscopic Converted to Open Sometimes when a surgery is planned as a laparoscopic procedure (small incision and use of the scope for surgery) but it is converted to an open (large incision to open visualization) for various reasons such as the presence of adhesions or other surgical obstacles. When a laparoscopic procedure is converted to an open procedure (even if they used the laparoscope at first) an open surgical procedure is billed instead. Most surgeries listed in the CPT book are “open” unless the word “laparoscopic” is included in the description. Many surgeries are listed twice, once as laparoscopic and once without mention of laparoscope, meaning they are open.

National Correct Coding Initiative The National Correct Coding Initiative (NCCI) defines what procedures are bundled into what other procedures. Billing/coding bundled components with the comprehensive procedure is not only redundant, it is called Unbundling or “a la carte” billing and the Medicare Program considers it to be a fraudulent billing practice.

Examples of Unbundling If you bill the endoscopy sites separately, for example, a esophagoscopy and a duodenoscopy when an EGD would contains the entire procedure in one code. If you bill the diagnostic endoscopy and the surgical endoscopy together. If you bill a converted laparoscopic procedure together with the same kind of open surgery. If you bill an Evaluation and Management “visit” on the day of the procedure.

Why Is Unbundling Fraud? Try this fast food example: If you ordered that burger combo that includes fries and a drink for $5.50…. but they ring up the Burger for $3.50, the Fries for $2.00 and the Drink for $1.50, your total is now $7.00! You have been over- charged! This is why Medicare considers unbundling (“a la carte billing) to be illegal. Image source: la-closer-to-banning-new-fast-food-restaurants/