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43239, 43226 & 43450

  1. #1
    Default 43239, 43226 & 43450
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    My physician performed and documented both dilation techniques;

    Esophagus: There was a tight stricture at 20 cm. This would not allow the scope to pass. It was biopsied x4. With manipulation a guide wire was passed through the stricture without difficulty to approximately 45 cm. The scope was then withdrawn. Over the guide wire the esophagus was then dilated with a #33, #36 and #39 Savary dilator. The scope was reintroduced and passed easily through the upper esophageal stricture at 20cm. the esophagus revealed a Z line around 30 cm with finger of Barrett to 29 cm. Biopsies x4 were taken from 29 to 30 cm. Mild esophagitis was noted. The stomach revealed mild antritis and biopsied x2 along the greater curve in the antrum for pathology and x2 for CLOtesting. On retroflex the fundus and body of the stomach were unremarkable except a moderate sized hiatal hernia. The pylorus was patent. The duodenum was normal to 110 cm and biopsied x2 at this point. The scope and guide wire were then removed. The esophagus was dilated with the #40 and #44 pillory dilator without difficulty. The patient tolerated the procedure well.

    There are CCI edits of "0" with 43239-43226 ?

    Any suggestions on billing would be greatly appreciated


  2. #2
    Boise, Idaho
    I would go with 43248
    You could use 43239, 43248-51

  3. Default
    I had the same confusion not too long ago and had to learn the long hard way

    My initial thought was 43239 with 43226 ... they I received denials and rejections, so I began using the -59 modifier ... then the -51 modifier ... and still nothing.

    Then I realized the manipulation codes (43450 , 43453)

    43453 holds a note of (For dilation with endoscopic visualization, see 43195, 43226)

    ... For my particular OP note, I was able to code the 43239 with 43453... My claim was accepted and paid.

    Hope this helps!

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