Choose 43255 For Control-of-bleeding Situations

When coding for excessive blood loss, modifier 22 may not be that ally you are looking for

. The answer may lie on more proper CPTs such as 43255 and critical care codes. Take cue from these two scenarios:

Think about endoscopy with injection as option

First Scenario: The doctor injects epinephrine into a duodenal ulcer to control active bleeding during endoscopy with biopsy.

Code it: Earlier, you may opt to use 43239 appended with modifier 22 if the physician required significant effort to control the patient's bleeding.

However, the option would need you to submit additional paper documentation to support your modifier 22 claim. In place of submitting yourself to potential hassles, you can accurately describe the session by reporting 43239 for the biopsy and 43255 for the control of bleeding provided that the bleeding was not caused by the biopsy.

As evident from 43255's descriptor, this procedure describes control of bleeding by any method, including injection.

Requirement: On your claim, you should append modifier 59 to 43255, and then report 43239. Omitting the modifier would give payers the feeling that the biopsy (or physician) caused the bleeding and bundle 43255 into 43239.

Extraordinary bleeding will require critical care coding

Second scenario: When the gastroenterologist is about to carry out an upper GI endoscopy, the patient experiences gastrointestinal bleeding so severe that the physician must suspend the endoscopy and spend 40 minutes lavaging blood from gastro-intestinal tract before continuing.

Code it: Here, the critical code 99291 is your best choice.

Here's why? If the gastroenterologist caused the bleeding, you can't bill for the control of bleeding procedure. You should call on control-of- bleeding codes only when treatment is required to control bleeding that takes place spontaneously or as a consequence of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention," states CPT Assistant.

Remember, the time spent at the bedside carrying out services including lavage of gastric blood is not included in the performance of a subsequent endoscopic procedure and is not part of the E&M service that might be carried out on the same day.

Nevertheless, you should not report a critical care code carelessly for an excessive bleeding situation that's not out of the ordinary. Additional time for emergency bedside services less that 30 minutes does not count as billable critical care service. For prolonged critical care services, the doctor should specifically note the amount of time in his notes.

by: James Article

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