Wiki 43248 (?)

[plynn]

Procedure Note:

Findings: Esophagus: There was a tight stricture at 30 cm. Moderate-to-severe erosive esophagitis was noted. This was biopsied x4. The scope would not pass. A guide wire was passed. The scope was removed. Over the guide wire the stricture was dilated with #27, #30, #33 and #36 Savary dilator without difficulty. The wire was removed. The scope was reintroduced and passed easily through the stricture. The stomach revealed mild antritis and biopsied x2 along the greater curve in the antrum for pathology and x2 for CLOtesting. On retroflex there was a moderate sized hiatal hernia. The pylorus was widely patent. The duodenum was normal to 110 cm and biopsied x2 at that point. The patient tolerated the procedure well.

Unsure what code, 43248 does not include the biopsies?

Appreciate any help you can give

Thanks

 

[coachlang3]

You'd use the 43248 and also a 43239. Depending on the payor you might need a 59 on the 43239 but for Medicare you do not need the modifier.

 

[scorrado]

Coach - I am curious as to why you would not use the 59 modifier with Medicare?

 

[tpontillo]

You use a 59 modifier with Medicare. Its the 51 modifier that you dont need for Medicare

 

[plynn]

Thank you all so much for your help

 

[coachlang3]

According to the NCCI edits (version 18.0 eff Jan 1, 2012 -Mar31, 2012) you do not need the 59 modifier on either procedure code as they are not bundled.

 

[scorrado]

I see that Coach - I just assumed and we all know what happens when you do that Luckily I have never had to code 43248 and 43239 together because I would have messed that one up.