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egd with balloon dilation & botox injection

Lisa A Posted Fri 04th of November, 2016 09:30:03 AM
EGD: Achalasia was noted. 20mm balloon dilation performed. 100 units of Botox injected. Is the use of -59 warranted on 43236, since it's the same site as 43249? Or only 43249?
SuperCoder Answered Mon 07th of November, 2016 09:56:17 AM

In the procedure code 43236, the provider performs one or more submucosal injections, so injection is included in the procedure itself, but dilation is not performed. Need not to append the modifier 59 with it. Whereas, in procedure code 43249, the provider performs esophageal dilation using a balloon (less than 30 mm), but no injection is bundled with the procedure. For injection you can use the code separately with the procedure code 43249.

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