Wiki GI procedures bundling

[Susan Carter CPC]

Hello,

When a provider does an esophagogastroduodenoscopy with biopsies but also does removal of a polyp or lesion in another area, besides the biopsy site, can these both be billed 43251 and 43239 with a modifier to unbundle the 43239, since they are different areas?

Also when doing colonoscopies the same scenario? can these be unbundled if it is a different area within the colon?

The NCCI edits bundle.

Thank you

 

[agovea30]

Hello,

When a provider does an esophagogastroduodenoscopy with biopsies but also does removal of a polyp or lesion in another area, besides the biopsy site, can these both be billed 43251 and 43239 with a modifier to unbundle the 43239, since they are different areas?

Also when doing colonoscopies the same scenario? can these be unbundled if it is a different area within the colon?

The NCCI edits bundle.

Thank you

Modifier 59 is allowed for both but you must remember the Modifier 59 guidelines.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

 

[clarkmegan]

Yes, you can bill for both as long as they are on different anatomical sites. I would use -XS (separate structure) modifier in lieu of -59

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

 

[kboyd22]

Prior to 2018 we billed these with the 59 modifier with no problem; Since 2018 began we are now getting denials as invalid modifier combo. Considered trying the X modifiers(previously our commercial payers didn't really recognize them), but was not real sure as to which one to use..XS is separate structure, but does a different area of the colon, like transverse qualify as a different structure from the ascending colon?