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Ask a Rev Cycle Expert: Hemospray® HCPCS C1052 With 43242 & 43270?

Question:

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).

Answer:

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.

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).