|
6.3.22 Endoscopies
The following endoscopies are benefits of Texas Medicaid:
• Bronchoscopy
•Cystourethroscopy
•Endoscopic retrograde cholangiopancreatography (ERCP).
•Lower gastrointestinal endoscopy (GED) (for example, colonoscopy)
•Upper GED (for example, esophagogastroduodenoscopy [EGD])
•Sinus endoscopy
Multiple diagnostic or operative endoscopies in the same or different body areas are often billed on the same day. If done by the same provider, they may be paid the full amount allowed for the major procedure and one-half the allowed amount for each additional procedure, following multiple surgical guidelines.
If the physician bills separate charges for multiple endoscopies that are considered part of a more inclusive procedure, the individual charges are reviewed, and only the most inclusive code is reimbursed.
Example: Separate charges for an esophagoscopy, a gastroscopy, and a duodenoscopy are reviewed and paid as an EGD. A surgical endoscopy always includes the diagnostic endoscopy.
|
