My question is regarding CPT billing and Icd-9 as well. My situation is as follows. On a gastric bypass patient, who is 3 years out from her bypass surgery returns to OR for an EGD, the physician performs the EGD and dilates the anastomosic site from the bypass. THis is done through the scope. I did not bill it with CPT 43245 as it says Gastric Outlet obstrustion as this is an anastomosis. I also billed with ICD-9 code for complication of surgery diagnsis 997.1. The doctor says this is the patients gastric outlet therefore, the 43245 and the 537.0 should have been billed. that since the patient is three years out from her surgery it can not be considered a complication of the surgery.
I need some imput and if anyone has anything written in black and white as back up I would appreciate that as well.
If I am wrong I will gladly resubmit a corrected claim.
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