Bleeding controlled before the scope ends

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare outpatient digestive professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Encounter

Fictional outpatient, age 58, has a diagnostic colonoscopy for documented rectal bleeding. The clinician advances the scope through the anus to the cecum and records adequate preparation. A single pedunculated sigmoid lesion is identified. The report does not identify a separate bleeding lesion elsewhere.

Intervention

The sigmoid lesion is removed by snare. The removal site immediately oozes. The endoscopist applies clips at that same site and confirms hemostasis before withdrawing the scope. This bleeding occurs as a result of the removal during the original procedure.

Timeline

The patient remains in the same procedure room throughout the removal and hemostasis. There is no discharge, recovery interval followed by another procedure, or return to the endoscopy suite. The note records one completed endoscopic encounter and transfer to recovery afterward.

Charge review

The proposed professional charges include the removal and an additional endoscopic bleeding-control service because clips were used. Evaluate the procedure relationship without confusing it with supply reporting or a later return encounter. Keep the original indication separate from the documented cause of this intra-procedure bleeding.

Your coding worksheet

Identify the exact bleeding site and cause.
Decide whether a separate return encounter occurred.
Evaluate the extra bleeding-control procedure.
Explain why the original symptom does not change this site’s operative relationship.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The bleeding arises at the removal site during the original intervention.
The timeline describes one procedure, not a later return to the suite.
NCCI C.11 includes the control of bleeding in this endoscopic relationship; the additional instrument does not establish a separate procedure.
The presenting symptom remains part of the record, but it does not convert bleeding caused by this removal into an independent intervention at another lesion.

Reference sections: C.11

Practice the linked chart questions