Wiki CPT 43239 and CPT 45380- I need help please!

Jm6161

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Hello Dear colleagues;
The following cpts are bill both together as both procedures need to be done on the same day and have the insurance pay for both procedures fully.

Right now some insurances are paying only 50% for the second one and some are not paying at all.

I need to find out is there a modifier that needs to be used, is there another type of prior auth that needs to be obtained. What needs to be done to get paid for both CPT codes if done on the same day because it NEEDS to be done on the same.

These 2 codes are frequently billed together and we need to figure out how to get them paid. Can anyone assist me with coming up with a solutions for this dilemma?
 
43239 and 45380

I bill these two codes continuously

Upper EGD and lower Colonoscopy. We generally find just Medica is the only issue with payment

But 43239 does need to have a modifier 51 attached to it. However from my standpoint I bill ASC facility so that may differ
 
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