Wiki Egd and ercp coding

[navila0508]

Any reason why 43235 would get denied when billed with ercp stent and stone removal? Medicare has denied two stating a co-b15 issue. "required that a qualifying service/procedure be recd and covered. Should i use a modifier 59 on it?

 

[rlmiller]

The base EGD CPT Code 43235 is included in the ERCP codes 43260-43278. The scope is inserted in the mouth to the bile tract. The esophagus, stomach, duodenum, are evaluated during the procedure and that is way you would code separately.