AAPC - Back to school
Results 1 to 3 of 3

Thread: 43251 & 43239 in Office Endoscopy Suite

  1. #1

    Question Correct code? 43239?

    AAPC: Back to School

    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. #3


    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.

Similar Threads

  1. office based surgical suite vs outpatient and inpatient hospital
    By j.monday7814 in forum Billing/Reimbursement
    Replies: 11
    Last Post: 03-18-2015, 09:32 AM
  2. billing/coding for in office surgery suite
    By snodine in forum Billing/Reimbursement
    Replies: 0
    Last Post: 02-08-2012, 02:04 PM
  3. billing for surgical suite in physicians office
    By ccambpell in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 01-10-2011, 10:10 AM
  4. Billing for the infusion suite in a physician's office
    By lintvedta in forum Billing/Reimbursement
    Replies: 0
    Last Post: 12-15-2010, 12:47 PM
  5. can EUS 43259 be coded with 43239 Upper endoscopy with biopsy
    By ncantello in forum Gastroenterology
    Replies: 2
    Last Post: 12-02-2008, 03:25 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.