AHA Coding Clinic® for HCPCS - 2023 Quarter 3; Ask the Editor
Polypectomy of colon by hybrid ESD and EMR technique
A patient presented for excision of an adenomatous colon polyp by a hybrid endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) technique. Gel was injected with adequate lift of the lesion from the muscularis propria. A circumferential incision was made around the lesion into the submucosa with a hybrid ESD knife. The periphery of the lesion was marked with the tip of the ESD knife with cautery followed by full circumferential incision. The lesion was then partially dissected (hybrid ESD) from the underlying deep layers with electrocautery. A snare was then placed around the lesion and snare cautery excision was performed. Some submucosal fibrosis was noted requiring the polyp to be excised partially en block and partially with piecemeal snare excision. The polyp was retrieved and the hybrid ESD resection defect was closed. May both CPT code 45390 and HCPCS code C9779 be reported when performed on the same polyp? How is this polypectomy by hybrid ESD/EMR reported? ...
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Article Overview
This premium article addresses coding for a colon polypectomy performed using a hybrid ESD and EMR technique. It is written for coders, billers, and clinical documentation staff who need to understand how the documented procedure is characterized for reporting purposes. The discussion focuses on the procedural scenario, relevant endoscopic technique terminology, and the coding question raised by the case.
Why This Topic Matters
Hybrid endoscopic resection techniques can create uncertainty when selecting the most appropriate reportable code. Accurate interpretation of the documented method is important for compliant claim submission and consistent coding.
What You Will Learn
- How the documented colon polypectomy is described procedurally
- How hybrid ESD and EMR terminology affects coding relevance
- What coding question the case is designed to address for endoscopic colon lesion removal
- How the procedure narrative may be interpreted in a coding context
Who Should Read This
- Medical coders
- Outpatient hospital coders
- Physician coding staff
- Billing personnel
- Compliance staff
Codes Discussed
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