• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

43251 & 43239 in Office Endoscopy Suite

TNavarre

Guest
Messages
30
Best answers
0
Correct code? 43239?


Our office staff billed 43251 & 43239 (-59). The carrier paid on 43251 and 43239 (-59) was unpaid, inclusive.

It was requested I appeal. After reviewing physician's Endoscopy Report I'm confused. Which code(s) should have been used?

According to the report: " In gastric fundus multiple sessile polyps, ranging in size from 15 mm. to 20 mm. were seen The polyps were completely excised by snare hot. The polyps retrieved."

"In gastric body, multiple pedunculated polyps, ranging in size from 15 mm were seen. The polyps were not bleeding. The polyps were completely excised by snare hot. The polyps were retrieved."

Doctor sent 1 specimen for H Pylori (Clotest) from antrum & Snare polypectomy times 2 from body.

I new in gastroenterology and the code fits the procedure(s) done. What is the correct way to code these procedure(s)

I only see an appeal for additonal payment for the underpaid code.

Thelma
 
Last edited:

amyce2693

Contributor
Messages
10
Best answers
0
there was only one technique used...the hot snare. if he had done a hot snare and a cold forcep, then you could bill the 43239.
 

pamsbill

Guest
Messages
113
Best answers
0
I bet the specimen for the H Pylori was a cold biopsy but he didn't dictate well enough to be able to bill both techniques. Use this as a teaching moment to show him you need thorough detail on the different techniques and the different locations.
 
Top