# 43235, 43450 and G0105



## bertll (Sep 25, 2013)

I code for a facility and the providor did an EGD (43235) with dilation (43450) as well as a screening colonoscopy (G0105).  Per CCI edits it doesn't appear I need to add a modifier at all, but in our encoder it is telling me I "may" need to add a -59 on 43235.  Any help as to what to do would be appreciated.


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## chewri (Sep 26, 2013)

The 43235 inclusive in the balloon Dilitation( 43450) The only time to bill a EDG with balloon dil is if there was a biopsy or something else done during the EDG. You would put a 51 modifier on the 43450. Hope this helps.


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## hbeard (Sep 26, 2013)

Sounds like you are billing medicare so I don't think you need to add any modifiers at all since they are all in different areas.


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## bertll (Sep 27, 2013)

Chewri-I believe I can use the 43450 also because it is not a balloon dilator code.


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## bridgettemartin (Sep 27, 2013)

43235 and 43450 are not inclusive of each other.  You may want to be sure your provider actually did a 43450.  This is an un-guided (Maloney) dilatation, that does not require endoscopic guidance.  If your provider did do both of these procedures, you can bill both, and they do not require a modifier, unless there is a payer-specific modifier needed. If your provider did a wire-guided esophageal dilatation, that would be 43248


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## jlgwalt64 (Dec 10, 2019)

Code 43235 is designated as a 'separate procedure', that's where the modifier 59 comes in.


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