jessirussell2003
New
We are now getting a frequent flow of denials, upheld denials after sending in NCCI Edits report, OP/Path notes and reconsideration letter for coding 43248 and 43239 together including the ins specific modifier. So I am asking for guidance as to how these should be billed. The ins companies are upholding denials d/t the 43248 (Dilation) and the 43239 (EGD w/BX) being both performed in the esophagus. It makes sense that yes they both are performed in the esophagus however you can't do a dilation with bx equipment and you can't do a bx with dilation equipment. So I totally feel this is fightable with the ins companies. I have previously added to my reconsideration letters about the equipment being different for each of those procedures and now just within the last month I am seeing the upheld denials based on they are both performed in the esophagus. I am looking for answers so we can fight these and get them paid. I thank you in advance. Jessica