Get a DRG grouping summary and IPPS payment calculation with your code search and crosswalks!Learn More

Ask an Expert

Answers to Compliance and Medical Coding Questions.
  1. Susan Posted 1 Year(s) agoRelated Topics

    In 2014 code 43258 was replaced by 43270, the verbage was the only thing that changed as far as I can tell. We had been using 43258 for treatment of Barrett's with no problems with insurance denials, of course in 2014 we started using 43270. We have had no denials when used 43270 for Barrett's until recently. BCBS Anthem denied stating 43270 was an investigational code and claim was not going to be paid. How can a code be investigational when it is a replacement code for a code that was never investigational? We have already sent records to appeal and when claim still denied made a call to provider rep with no resolve. Please advise on what the next step would be, this is not an investigational COde

  2. SuperCoder Posted 1 Year(s) ago

    Hi, our expert team is looking into this query. We will get back with the solution soon. Thank you.

  3. SuperCoder Posted 1 Year(s) ago

    Hi Susan,

    Please send some details of the case which has been denied, were there any other codes billed with 43270? If we get some clarity on this we shall be able to determine what actually went wrong with it. 43270 is considered by some payers as diagnostic as well as therapeutic code. Therefore, in case if only 43270 was billed, then checking with your payer preference is strongly suggested. Thank you.

  4. Susan Posted 1 Year(s) ago

    What is the fax number so that I can send you the report

  5. Susan Posted 1 Year(s) ago

    Scope advanced to the second part of the duodenum. Esophagus and gastroesophagus junction examined, Barrett's esophagus present. Radiofrequency ablation of Barrett's esophagus was performed using Halo 360 catheter and balloon based endoscopic ablation system.Guidewire passed down endoscope then withdrawn leaving guidewire in place.Self sizing radiofrequency ablation balloon passed over guidewire into esophagus.Balloon ablation catheter inflated and energy applied at 10 J/cm2.This was repeated until top of gastric folds reached.Ablation catheter and and guidewire removed,ablatiion zone was cleaned and then cleaned of coagulation debris. This process was repeated twice until Barrett's mucosa had been ablated. The key word through out this procedure is ABLATION. 43270 is EGD with ABLATION of tumor,polyps other lesions, includes pre and post dilation and guidewire. Don't see hoiw how 43270 is investigational when it replaced 43258. The only difference is the verbage. How do I fight the denial stating 43270 is investigational?"

  6. Susan Posted 1 Year(s) ago

    BCBS Anthem's policy states that 43270 is investigational unless patient has high-grade dysplasia. The patient had an EDG with Biopsies and the biopsies showed no dysplasia. Can code a 43239 because the scope went to the past the second part of the duodenum? Our provider needs to get paid for this procedure. Any advise would be welcome.

  7. SuperCoder Posted 1 Year(s) ago

    Unlisted code 43499 should be appropriate when radiofrequency ablation of Barrett’s esophagus is specified. Because unlisted codes spur automatic review, clear and accurate documentation of the procedure should accompany the claim. Also a cover letter should be included stating the reason for using the unlisted procedure code. This separate report should explain, in simple, straightforward language, exactly what the physician did. Thank you.

  8. Susan Posted 1 Year(s) ago

    Thank you

  9. SuperCoder Posted 1 Year(s) ago

    Happy to help!

About this Question

  • Posted by 25547 Susan, 1 Year(s) ago. There are 9 posts. The latest reply is from SuperCoder.