by Robert S. Gold, MD
We learn something new every day. For the past several years, I’ve been complaining about advice in a particular Coding Clinic—both in the index and in the world of practical, day-to-day coding. Below is a recent letter I wrote to CMS.
It has been my contention that Coding Clinic, first quarter 2001, pp. 16–17, incorrectly defined an interventional procedure—percutaneous endoscopic gastrojejunostomy (PEGJ)—and assigned it to ICD-9-CM procedure code 44.39. Eventually, a specific code for that procedure came into being and was further elucidated in Coding Clinic, October 2001, as ICD-9-CM procedure code 44.32. It is identified as an operating room (OR) procedure, and coders assigned this new code based on old definitions. As a result, hospitals have received millions of dollars for a procedure that the gurus (i.e., CMS, National Centers for Health Statistics, and their physician advisors) incorrectly defined. However, these same gurus assigned the procedure a status that is based on the correct definitions—which we don’t have.
