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Coding for Band Ligation 43244 and Balloon dilation 43249

Joseph Posted Mon 14th of November, 2011 14:34:02 PM

The indication for the procedure is Dysphagia;Esophageal varices.

A band ligation was preformed for esophageal varices and a balloon dilation had to be preformed for esophageal stenosis. There was also portal hypertensive gastropathy and a hiatal hernia found. I know I would append the esophageal varices to the band ligation and append esophageal stenosis to the balloon dilation. Does either procedure need a modifier 59 or 51 and if so to which procedure would I append the modifier. This is a Medicare patient. Thanks for any help you can give me on this situation.

SuperCoder Answered Mon 14th of November, 2011 16:13:49 PM

Use CPT 43205 for if the physician uses a suction tip to lift the varix and places a rubber band around the base of the varix. Additionally, use CPT 43220 when the physician uses an esophagoscope to place a balloon and dilate the esophagus.
43205
43220-51

Joseph Posted Mon 14th of November, 2011 17:39:46 PM

I should have stated that this was an upper gastrointestinal endoscopy using procedure codes 43244 for the band ligation and procedure code 43249 for the balloon dilation. So does either procedure need a modifier 59 or 51? This is a Medicare pt. Thanks for any help.

SuperCoder Answered Mon 14th of November, 2011 22:33:54 PM

43244
43249-51

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