Wiki EGD w/EUS w/cold forcep biopsies

[ssmith955]

Physician performs EGD with endoscopic ultrasound to the second portion of the duodenum, biopsies are taken with cold forceps in the esophagus due to mucosal changes. I have been billing 43259 for the EUS and 43239/59 for biopsied with cold forceps, of course the 43239/59 is being denied. My issue with the EUS codes with biopsies is that the description states Fine Needle Aspiration/Biopsy, aspirate or biopsy a mass. There is no clear definition in these cpt codes for how the biopsy of the mass was taken. Provider clearly used cold forceps to bx the mass not FNA. I do not want to cheat provider out of services that were clearly performed nor do I want to be billing inappropriately for the services. Please help to clarify the coding issue on EUS w EGD/bx. Any thoughts or info would be appreciated and if other GI coders have this same issue please relay how your office codes these. Thank you

 

[Kisalyn]

I don't code a lot of EUS/bx anymore since I started coding for peds GI. I can tell you when I used to, that is the way I sent them in (43259/43239-59). It's been about a year, but I don't remember having problems getting both paid. You or your A/R dept. may have to start appealing. These are two separate procedures and sometimes, but not always, have different indications for each procedure.

 

[ssmith955]

EGD w/cold forcep bx and EUS

Thank you for your input. I have been billing the same 43239/59 and 43259. Just wanted to clarify that I am posting correctly.