tci Outpatient Facility Coding Alert - 2014 Issue 10

Reader Question: Don't Code Service to Fix Problem Caused By the Physician

Question: My doctor attempted to do a banding of esophageal varices. He could not put the bands on, but in the process caused active variceal bleeding. He treated the bleeding with sclerotherapy. Should I report the banding of the esophageal varices, the sclerotherapy, or both? Missouri Subscriber Answer: Report 43244 (Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal / gastric varices) with modifier 53 (Discontinued procedure). Be sure to include a copy of the operative report with the claim so the payer can understand why the gastroenterologist discontinued the procedure. In the facility setting you would report modifier -73...

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