Wiki Coding

[fcctn-2008@yahoo.com]

A patient is having an EGD 43235 and the procedure was precerted by the INS , when the provider went to do the procedure it changed to 43239,

how do I bill this , should I use any modifier or leave the 43235 and use a modifier , and which modifier should I use .
thank you

 

[thomas7331]

You can only bill for what was actually performed - if CPT code 43239 best represents what the provider performed, then that's what you'll have to submit. There is no modifier specific to this situation, but you may wish to contact the insurance company to have them update their authorization to reflect the new code in order to prevent the claim from being denied.