Ask a Rev Cycle Expert: Hemospray® HCPCS C1052 With 43242 & 43270?
Can Hemospray® (C1052) be reported/charged when the patient presents for an EGD with biopsy? Bleeding is caused because of the procedure and Hemospray® is used to control bleeding at the biopsy site. Bleeding is not present prior to the EGD therefore the following CPT codes would need reported (43270 & 43242).
Unfortunately, Current Procedural Terminology (CPT®) codes 43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) and 43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) are not on the list of procedures that have been approved for the use of Healthcare Common Procedure Coding System (HCPCS) code C1052 Hemostatic agent, gastrointestinal, topical (Hemospray®). Please see MLN Matters® article MM12120 January 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS) publication for a list of CPT® codes that may use HCPCS C1052.
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