Wiki 43248 allowed with 43239

[salligood]

Is 43248 for esophageal stricture allowed with 43239 with modifier 59 for barrets esophagus being in the same anatomical site?

 

[thomas7331]

My opinion on this is that the documentation has to have something to back up the modifier and show that these were somehow separate if you use it to unbundle these. If the two procedures were on the same anatomical site, and done at the same encounter by the same provider, and through the same scope, then I think it would be tough to defend the use of the modifier in the event of an audit.

 

[vhuscher]

According to CMS guidelines—dilation and biopsy same spot—only dilation is billed.