Wiki Code 43247 Pushing a food bolus to the stomach

[codingman]

Hi Guys,
I have a question on the code 43247. If the doctor Dilates the esophagus (noted in the report) and pushes a food bolus in the stomach, can you bill both the 43249 (20mm with balloon), AND 43247 he pushed the bolus into the stomach. Is this appropriate to bill both. OR is it JUST the 43239 because the food bolus didn't exit the body? If you could give me an answer that would be fantastic. If you had a name of a resource that I could refer to that would be top notch. Thanks in advance for your help. Happy New Year, and all the best to you and your family in 2010.

I have also found a piece of documentation from the AMA saying that you would bill a 43235 - 22 or 43239 -22 if a biopsy was done when the bolus is pushed to the stomach. This is assuming that the doctor was in the stomach and duodenum. Otherwise the AMA directs you to 43200-22 43202-22. Is this correct? The date says 1/2008. If this is correct would the 51 modifer go on the dilation code?

Please help if you are a strong GI coder who has seen this before. Please include reference material. THanks.



Kevin Humphrey, CPC, CGSC
Inpatient/Outpatient Coder
Dean Riverview Clinic
608-758-7515
tie line 570
kevin.humphrey@deancare.com


P.S. We are split, one coder says yes, and one says no. I'm leaning toward both codes because the bolus was removed from the esophagus just not the body.

 

[mhcpc]

I can help with the food bolus pushed into the stomach and the dilation. These are not bundled and can be charged together according to NCCI edits. 43247 is the correct code for pushing a bolus into the stomach according to the last GI coding conference I went to put on by the AGA.

As for the following, "I have also found a piece of documentation from the AMA saying that you would bill a 43235 - 22 or 43239 -22 if a biopsy was done when the bolus is pushed to the stomach. This is assuming that the doctor was in the stomach and duodenum. Otherwise the AMA directs you to 43200-22 43202-22. Is this correct? The date says 1/2008. If this is correct would the 51 modifer go on the dilation code?" I have never heard of this.

Hope this helps some.

Michele R. Hayes, CPC, CEMC, CGIC

 

[codingman]

Thank You Michele

Michele,

Thank you very much for your reply it is very helpful. I wanted to be sure capture all the revenue for services rendered. Thanks again for replying, and have a great weekend!