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Difference between 43255 and 43236?

Lisa Posted Fri 29th of June, 2012 14:40:11 PM

Can you give an example for submucosal injection?

SuperCoder Answered Fri 29th of June, 2012 21:23:46 PM

Question: If we report a submucosal injection with a polypectomy, it is considered as two codes. If we report it with a dilation, is it bundling? If we bill the submucosal injection, does it need a J code, or does the hospital bill for that?

Answer: You are correct in that you may report most submucosal injections with polypectomy. The exception to this rule is 43251 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). The National Correct Coding Initiative (NCCI) bundles 43236 (... with directed submucosal injection[s], any substance) into 43251.

The story is similar for the dilation codes. You may report the injections separately from the dilations for esophagoscopies (43220), sigmoidoscopies (45340), and colonoscopies (45386). However, NCCI bundles 43236 into the EGD dilation code (43249).

You should not bill for the drugs when the physician performs the procedure in the hospital, since he did not purchase them and the hospital did. But you can bill using a J code when the procedure is performed in the office.

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