# CPT code 43239 Denial



## NESmith (Aug 9, 2012)

Good Afternoon. Please explain whay this was denied.

EGD Procedure Report: 
Introduction: A 48 yr old female patient presents for an elective EGD
Indications: GERD
                  Intermittent dysphagia in response to solids
Consent: The benefits, risks, and alternatives to the procedure were discussed and informed consent was obtained from the patient .
Preparation: EKG, blood pressure, pulse oximetry and respiration were monitored throughout the procedure.
Medications: MAC anesthesia. Propofol 330 mg IV throughout the procedure.
Procedure: The gastroscope was passed through the mouth under direct visualizationand was advanced with ease to the 2nd portion of the duodenum. The scope was withdrawn and the mucosa was carefully examined. The views were good. The patient's toleration of the procedure was good.
Endoscopic Impression: Normal esophagus
                                   A ring was present in the GE junction. Schatzki's. Dilatation was 
                                   performed.
                                   Dilatation was performed. A 54 FR dilator was passed.
                                   Irregular Z-line
                                   A hiatus hernia was found in the GE junction
                                   Normal stomach. Biopsy taken
                                   Normal duodenum
Findings: Esophagus is normal
              GE junction: There was a Schatzki's ring in the GE junction. Without fluoroscopic 
                                 guidance, the dilatation was perfomred, using a Savary bougie with 
                                 a guidewire. 1 pass was made. A 54 Fr dilator was pased. 
                                 Moderate force was required. Irregular Z-line. A random biopsy was
                                 taken. There was a 2.5 cm sliding hiatus hernia visible in the GE 
                                 junction to entry point.
              Stomach:    The stomach is normal. A random biopsy was taken. The specimen
                                was collected for a urease test for H pylor.
              Duodenum:  The duodenum is normal
Procedure coded as: 43248
                               43239-59
Insurance is UHC and they use Ingenix and it is denying the CPT code 43239-59. 
Could anyone tell me why. Thanking You in advance for your help in this matter.


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## MoonSad137 (Aug 9, 2012)

What DX did you use?

What was their reasoning (per EOB)?  Looks like a simple appeal is in order.


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## coachlang3 (Aug 10, 2012)

To me this is how I would've submitted charges for that procedure:

43248 (no modifier) 530.81,787.20,530.3

43239 (59 modifier) 530.81,787.20

Never had problems with anything like this but UHC can be weird sometimes.

I agree with Moon looks like a simple appeal is in order, I hope.


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