I can't seem to find any info on this situation and hope someone out there can help me. Doc does an endoscopy to duodenum. Found an obstruction in gastroesophageal junction and did a Maloney dilation.
The doc found a similar question in a Gastro coding newsletter that states we should bill a 43235 and also a 43450 because this does not fall into a CCI bundle. It goes on to say we were should NOT append modifier -59 for the dilation.
My question is this:
Is the only reason why these 2 codes can be billed because there is no specific definition under the endoscopic codes related to the MALONEY dilation? As in- if the doc had done a balloon dilation we would code as only 43249 but because it was Maloney it should have the two separate codes?
Is it related to the fact that the endo was diagnostic?
I am confused and would like to see if I can get any feedback on this issue.
Thanks in advance to your comments.
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