Wiki Is CLO test charged with EGD with lesion removal by hot bx

[johnathan]

One of our surgeons performed a EGD with Lesion removal by hot biopsy and also took a specimen to be sent for CLO testing for H.Pylorie. Should he charge for the collection of the specimen?

I can not find anywhere that it expressly states whether obtaining a specimen for CLO testing for the presence of H.Pylorie should be charged. If it is charged, I assume it is charged as procedure 43239.

The Encoder Pro bundles 43250 (Hot Biospy) and 43239 together but says that a modifier may be used if the 43239 is performed on a separate lesion. It is not being done on a separate lesion. It is taken from normal looking mucosa usually.

So do I charge only 43250, or 43250 and 43239-59?

 

[Mary Rapp]

you would bill the 43250 for the biopsy and 87077 with Mod QW for the CLO test.

 

[db1234]

Our surgeons perform EGD at the hospital. We do not bill the lab code because the facility bills that. We do bill 43250 and 43239-59 and are reimbursed for both codes.

 

[lseiter]

Our surgeons perform EGD at the hospital. We do not bill the lab code because the facility bills that. We do bill 43250 and 43239-59 and are reimbursed for both codes.

this is the correct way to bill if it is "seperate lesions removed during same operative session by different technique" you can bill with the 59 modifer