Wiki To 43236 or not to 43236? That is the question

[gina_marie]

The op report states "A benign high grade instrinsic stricture was seen in the GE junction that did not allow the endoscope to traverse. 4 .05 ml kenalog injections were successfully applied for drug delivery. This was applied in all four quadrants of strictured area to reduce the likelihood of restricturing. Stricture disrupted with biopsy forceps in 4 quadrants. A 10 mm stepwise balloon was introduced for dilation and the diameter was progressively increased to 12 mm successfully. The endoscope was able to traverse the stricture after dilation."



The argument is you cannot bill 43236-59 with 43249 because it is not a separate site. It is however, a separate procedure. The injection was done, the stricture disrupted and then the dilation was done.

Thoughts? Any help appreciated.

~G

 

[pamsbill]

You cannot bill the 43236. Unlike colonoscopies, upper endoscopy injections do require the 59 modifier. Since it is the same site, adding a 59 would be erroneous, as you would be indicating it was a separate site.

Go with your gut on this one. IMO, you are correct.