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Gastroenterology Coding Alert

Reader Question:

Follow Multiple Endoscopy Rules for Multiple Endoscopies

Published on Tue Feb 14, 2012

Question: Whenever our gastroenterologist performs an EGD with balloon dilation and EGD with biopsy, we submit our claims using these codes 43249 and 43239-59. This is based on the RVUs: 43249 is 5.23 and 43239 is 5.15. However, we have now noticed that we are being paid with 43239 as the primary code although it carries lesser RVU. Can you explain?Arkansas SubscriberAnswer: According to the coding scenario that you have provided, you are right in reporting the procedures with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) and 43249 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus [less than 30 mm diameter]). You are correct until this point.However, you should not report these codes with the modifier 59 (Distinct procedural service) because you will not find a [...]
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