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.”
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Flexible Endoscope
The endoscope is basically a camera in a tube which can be
inserted into body cavities or organs.
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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
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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 (43200-43232).
 Esophagogastroduodenoscopy (almost always
abbreviated: EGD) crosses the pylorum and views
the esophagus, stomach and duodenum (4323443259).
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
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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
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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
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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 overcharged! This is why
Medicare considers
unbundling (“a la carte
billing) to be illegal.
Image source: http://www.dietsinreview.com/diet_column/07/
la-closer-to-banning-new-fast-food-restaurants/