suemt
Expert
I am confused by a case and would like any opinions or feedback you may have.
Upper GI endoscopy is performed, and findings include esophagus, stomach & duodenum, with retroflexion in the stomach. Finding include papule/nodule in stomach, so a US is immediately performed on the stomach only to further diagnose the finding (final impression/diagnosis = lipoma).
First, I see 43235 with the esophagogastroduodenoscopy (Medicare fee schedule in my area = $379.42), but then as I read through all the various coding language to account for the second procedure (the US of the stomach), I see 43237 - with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures (Medicare fee schedule $251.37)
I also see 43259, but I read this to mean ALL 3 areas must both be scoped AND US'd, which is not what my provider did (she only US'd the stomach).
NCCI edits tell me 43237 cannot be billed with 43235, but it doesn't make sense to me that the provider would be paid LESS for doing MORE, so I must be missing something.
Can anyone explain this? Is there a different code I should be using? According to NCCI I can't use modifiers.
Thanks for any feedback on this.
Upper GI endoscopy is performed, and findings include esophagus, stomach & duodenum, with retroflexion in the stomach. Finding include papule/nodule in stomach, so a US is immediately performed on the stomach only to further diagnose the finding (final impression/diagnosis = lipoma).
First, I see 43235 with the esophagogastroduodenoscopy (Medicare fee schedule in my area = $379.42), but then as I read through all the various coding language to account for the second procedure (the US of the stomach), I see 43237 - with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures (Medicare fee schedule $251.37)
I also see 43259, but I read this to mean ALL 3 areas must both be scoped AND US'd, which is not what my provider did (she only US'd the stomach).
NCCI edits tell me 43237 cannot be billed with 43235, but it doesn't make sense to me that the provider would be paid LESS for doing MORE, so I must be missing something.
Can anyone explain this? Is there a different code I should be using? According to NCCI I can't use modifiers.
Thanks for any feedback on this.