E/M Coding Alert - 2014 Issue 10
Reader Question: Don't Code Service to Fix Problem Caused By the Physician
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Article Overview
This reader Q&A discusses coding considerations for a gastrointestinal endoscopy scenario involving an attempted variceal procedure, an interrupted service, and treatment of a complication during the same session. It is aimed at coders and billing staff who need to understand how the article frames facility and professional reporting, related modifier use, and the role of the Correct Coding Initiative and Medicare Part B guidance. The article is useful for reviewing how premium coding guidance addresses procedure discontinuation and treatment of complications without revealing the underlying decision details.
Why This Topic Matters
It helps coders and billers recognize when a service may be treated as discontinued and when additional treatment for a complication should be considered separately or not, based on payer guidance and coding policy.
Article Sections
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Question
A brief clinical coding scenario involving an attempted gastroenterology procedure and a complication that arises during the encounter.
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Answer
Coding guidance for the scenario, including discussion of professional and facility reporting and reference to applicable payer and policy considerations.
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Policy note
A general statement referencing Medicare Part B coding policy and the Correct Coding Initiative in the context of complications arising during an operative session.
What You Will Learn
- How this type of endoscopy-related coding question is framed in a reader Q&A format.
- How the article addresses reporting when a planned procedure is not completed.
- How the article discusses treatment performed for a complication during the same session.
- How payer policy and national coding guidance are referenced in the discussion.
Who Should Read This
- Medical coders
- Billing staff
- Gastroenterology practice staff
- Hospital outpatient coding staff
- ASC coding staff
Codes Discussed
Modifiers Discussed
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