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Question Coding Gastro


Baker, LA
Best answers
I would like to know if I can code 43239-59 with 43255. The situation is Physician did an EGD with biopsy and hemostasis. These were his findings
Esophagus - The esophagus was unremarkable. Bx taken. There was a small distal hiatal hernia.
Stomach - The stomach fundus showed a bleeding Dielafoy lesion that was clipped with a hemostatic clip with good hemostasis. The antrum showed patchy erythema. Bx taken.
Duodenum - Unremarkable examined up to the third portion.
Post operative Complication – No immediate complication after the procedure.

I was told that I cannot code 2 codes from the same family but I thought I could if it is in a different area. Thanks


Dragoon, AZ
Best answers
You can code both the 43239 and 43255 based on the scenario that you explained above. If the bleeding was from the biopsy location in the esophagus then that would be bundled into the 43239 code. Since it was a different lesion/structure (in the stomach fundus) then you can code for the 43255 separately.

There is a CPT Assistant Coding Communication from September 1996 (kind of old) but it states that the control of bleeding codes are intended to be used when treatment is required to control bleeding that occurs spontaneously, or as a result of a traumatic injury. Control of iatrogenically caused bleeding is bundled into the procedure that resulted in the bleeding.

I ran this through my NCCI edit checker and it looks like 43255 is the column 2 code in this edit. So you would append modifier -59 or -XS to CPT 43255 indicating the separate lesion/structure. Hope that helps!