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44366 with 43235 -59?

Maarit Posted Sat 21st of January, 2012 00:23:17 AM

My question is: if enteroscopy is done into 3rd segment of duodenum, but he is also looking for GI bleed on the way down in the upper sections, could I justify billing for 44366 and 43235 -59 both? Coding tips say “report the appropriate endoscopy for each anatomic site examined”, but is this a stretch?

In the OP note: standard scope buckled in the stomach and was exchanged to pediatric colonoscope which was advanced to 3rd segment. a bleed in the 3rd section of duodenum is stopped by a gold probe and two clips.

SuperCoder Answered Mon 23rd of January, 2012 16:45:32 PM

43235 has a higer RVU(8.95) than RVU of 44366, i.e; RVU(7.75). When checking CCI edits, 43235 allows modifier 59. It is also to be noted that 43235 is a separate procedure. When this is a scenario, the medical necessity plays a key role.
If the medical necessity does specify some abnormality within the region of esophagus and stomach till the point the first time endoscopy was done and the abonromality was one of the focus of that endoscopic exam. Also, there is focus on bleeding in the duodenal region and its therapy in the 2nd scope when the first scope buckled in the stomach. If all these justified by the diagnosis codes, this would help coding 44366 and 43235-59 in combination.

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