Gastroenterology Coding Alert

Question: The provider cauterized a bleeding ulcer in the stomach and took a biopsy from a separate area. We billed 43255 along with 43239-59. The claim was denied. What do we need to do?

Mississippi Subscriber

Answer: You need not specifically mention about control of bleeding in your coding, because an endoscopic procedure includes control of bleeding caused by the procedure itself. However, if you are referring to control of bleeding in a separate location, you may report 43255 (Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method) along with modifier 59 (Distinct procedural service), in addition to the primary procedure 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple).