Wiki Egd w/ dilation

[tldixon@mokancomm.net]

Need some help with this:
43235
43450
BCBS of KS is denying the 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes)
Anyone have any suggestions as to what else can be used?
Thanks,

 

[sheardmd]

We use 43249 for our EGD w/dilation - but you would only be able to charge that code since the 43235 is part of it.

 

[Kisalyn]

What's the denial reason? We usually have no problems billing both, but a few payers want modifier 59 on the dilatation.

 

[tldixon@mokancomm.net]

Egd with dilation

They denied because payment included in another service/procedure. I have added the -59 modifier once before, but they still denied.

 

[tldixon@mokancomm.net]

EGD with Dilation

CPT code 43249 is for a tansendoscopic balloon dilation. A bougie was used on this patient, so I cannot use that code.

 

[Kisalyn]

You proabably will have to appeal the 43450. The edits don't show any bundling between the two.

 

[chewri]

They do not pay for a diagnostic endoscopy with a balloon dil. It is inclusive. You can charge endo if bx or anything else was done other then a 43235.