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Wiki Egd and ercp coding

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navila0508

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Any reason why 43235 would get denied when billed with ercp stent and stone removal? Medicare has denied two stating a co-b15 issue. "required that a qualifying service/procedure be recd and covered. Should i use a modifier 59 on it?
 
The base EGD CPT Code 43235 is included in the ERCP codes 43260-43278. The scope is inserted in the mouth to the bile tract. The esophagus, stomach, duodenum, are evaluated during the procedure and that is way you would code separately.
 
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