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43251 & 43239 in Office Endoscopy Suite

  1. Question Correct code? 43239?
    Medical Coding Books

    Our office staff billed 43251 & 43239 (-59). The carrier paid on 43251 and 43239 (-59) was unpaid, inclusive.

    It was requested I appeal. After reviewing physician's Endoscopy Report I'm confused. Which code(s) should have been used?

    According to the report: " In gastric fundus multiple sessile polyps, ranging in size from 15 mm. to 20 mm. were seen The polyps were completely excised by snare hot. The polyps retrieved."

    "In gastric body, multiple pedunculated polyps, ranging in size from 15 mm were seen. The polyps were not bleeding. The polyps were completely excised by snare hot. The polyps were retrieved."

    Doctor sent 1 specimen for H Pylori (Clotest) from antrum & Snare polypectomy times 2 from body.

    I new in gastroenterology and the code fits the procedure(s) done. What is the correct way to code these procedure(s)

    I only see an appeal for additonal payment for the underpaid code.

    Last edited by TNavarre; 12-02-2008 at 03:57 PM.

  2. #2
    there was only one technique used...the hot snare. if he had done a hot snare and a cold forcep, then you could bill the 43239.

  3. Default
    I bet the specimen for the H Pylori was a cold biopsy but he didn't dictate well enough to be able to bill both techniques. Use this as a teaching moment to show him you need thorough detail on the different techniques and the different locations.

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