43235, 43450 and G0105

[bertll]

I code for a facility and the providor did an EGD (43235) with dilation (43450) as well as a screening colonoscopy (G0105). Per CCI edits it doesn't appear I need to add a modifier at all, but in our encoder it is telling me I "may" need to add a -59 on 43235. Any help as to what to do would be appreciated.

 

[chewri]

The 43235 inclusive in the balloon Dilitation( 43450) The only time to bill a EDG with balloon dil is if there was a biopsy or something else done during the EDG. You would put a 51 modifier on the 43450. Hope this helps.

 

[hbeard]

Sounds like you are billing medicare so I don't think you need to add any modifiers at all since they are all in different areas.

 

[bertll]

Chewri-I believe I can use the 43450 also because it is not a balloon dilator code.

 

[bridgettemartin]

43235 and 43450 are not inclusive of each other. You may want to be sure your provider actually did a 43450. This is an un-guided (Maloney) dilatation, that does not require endoscopic guidance. If your provider did do both of these procedures, you can bill both, and they do not require a modifier, unless there is a payer-specific modifier needed. If your provider did a wire-guided esophageal dilatation, that would be 43248

 

[jlgwalt64]

Code 43235 is designated as a 'separate procedure', that's where the modifier 59 comes in.