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EGD w/Dilation and Biopsy

  1. #1
    Question EGD w/Dilation and Biopsy
    Exam Training Packages
    One of our physicians did an EGD w/Balloon Dil plus several biopsies. I an not finding a code for just a Balloon Dil or just biopsies. Can someone please help? Any suggestions would be helpfull. Thank you.

  2. #2
    Location
    Hyattsville Maryland
    Posts
    53
    Default EGD/w balloon dil and bx
    Take a look at 43249 and 43239. See if this is appropriate.
    Catherine Du Toit CPC, CPMA, CGIC,
    AAPC Professional

  3. #3
    Location
    Beaverton, Oregon Chapter
    Posts
    115
    Smile EGD w/balloon dil
    I bill for gastro daily. The EGD w/biopsy 43239, with balloon dilation 43235,59
    These two codes go together because of anatomical distance. The EGD w/biopsy covers entry into the duodenum and/or jejunum as appropriate.
    If you are using Upper GI endoscopy 43234, including esophagus, you would then use 43249,59 (balloon dilation of esophagus)
    Hope that clears up the confusion!!

  4. #4
    Location
    Beaverton, Oregon Chapter
    Posts
    115
    Smile EGD w/balloon dil
    I bill for gastro daily. The EGD w/biopsy 43239, with balloon dilation 43235,59
    These two codes go together because of anatomical distance. The EGD w/biopsy covers entry into the duodenum and/or jejunum as appropriate.
    If you are using Upper GI endoscopy 43234, including esophagus, you would then use 43249,59 (balloon dilation of esophagus)
    Hope that clears up the confusion!!

  5. Default
    43239 and 43249 is correct. Unless a balloon is used that is more than 30mm in diameter, then use 43258. This is used when the patient has a diagnosis of achalasia.

    You cannot bill 43239 with 43235 or 43234, per the CCI it is bundled, no modifier is allowed. 43234 and 43249 are also bundled per the CCI.

    43235 and 43234 are not even codes for dilation, they are only for examination/diagnostic. Diagnostic codes are always included in the therapeutic codes and are not separately reportable.

    I have been coding GI for three years.....use 43239 and 43249 or 43258, as appropriate per the documentation.

    Just a note, some payers want a 59 on 43239, when these codes are used together. They do not bundle per the CCI, but they want it anyway.

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