Wiki 43239/43248-51


Dawsonville, GA
Best answers
I am new to GI coding. I have heard and read that modifier 51 is not necessary. I am trying to code an EGD w/ biopsy 43239 and EGD guidewire followed by dilation 43248. Should I add a 51 modifier to 43248? I have read the threads in the modifier section regarding modifiers 51 and 59. I would like to know what some other GI coders do for these codes.

From my experience and from what I've learned on these forums and from general education:

51 is when you have multiple procedures in different parts of the anatomy. IE: colon and esophagus.

59 is when you are doing multiple procedures in the same part of the anatomy that are considered a part of each other. IE colon with snare and colon with biopsy.

According to the CCI edits there is no modifier needed for the two codes you have asked about. BUT, it also depends on the payor.
when it comes to gi you use a 51 if you are doing an upper and a lower procedure and you use a 59 if you are doing more than 1 upper or more than 1 lower. example colonoscopy with biopsy and polypectomy by snare would be 45385,45380-59. Colonoscopy and EGD would be 45380,43235-51.