Wiki 43239 & 43235

[CBarry21]

Good evening,
I was wondering if anyone else has run into an issue with the billing of 43239 & 43235 being billed together and one being denied? The biller at the company I work for has been just resubmitting claims over and over with these 2 codes w/ a modifier 59. Is it possible to get these claims paid for if billed on same day?
When I did research it did say they can NOT be billed together. Is this true or is there a way to get it paid if done together?
Please and thank you for all help ahead of time!!

 

[csperoni]

43239 and 43235 are CCI edits marked as never being paid together. Adding -59 or any other modifier will not override that. You will not get paid for the 43935.

 

[haraml7]

Hi, so 43235 is a diagnostic procedure, if no other procedure was performed you would bill the diagnostic 43235 by itself. However, in your case a biopsy was performed, which trumps that diagnostic procedure (43235). It's like if a provider plans a lap procedure and goes in as lap and then converts to open, you cannot bill the lap, the open procedure trumps the lap because it is a more extensive procedure. The same would apply for the endoscopic procedure, the 43239 would Trump your diagnostic procedure. I hope that helps.