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Gastroenterology Coding Alert

Reader Questions:

Stent Placement Code Overrides Dilation

Published on Wed Sep 08, 2004

Question: I was coding a transendoscopic stent placement claim. The endoscopic report read, "Stenosis of pyloric channel and duodenal bulb ... significant gastric outlet obstruction, therefore balloon dilation carried out." Can I report both endoscopy codes with modifier -59 (Distinct procedural service) attached?

Alabama Subscriber Answer: You cannot report both procedures. On the claim, file only 43256 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement [includes predilation]).
 
Why? According to CPT 2004, "Do not report 43245 (... with dilation of gastric outlet for obstruction [e.g., balloon, guidewire, bougie]) in conjunction with 43256." Medicare will deny any claim for a single session that includes both 43245 and 43256.
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