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EGD with esophageal balloon dilation and biopsy

Tanesha Posted Thu 13th of September, 2018 22:27:18 PM
There is a CPT assistant (CPT Assistant, July 2018 Page 14) that states 43239 and 43249 can be coded together with a modifier on the same day, but can both be coded for the same site (esophagus)? If different sites, then I would usually pick up both codes. The CPT assistant doesn't mention this specifically. It states "modifier 59, Distinct Procedural Service, appended because they describe distinctly different procedures." They are distinctive procedures so it would seem there wouldn't be an edit in the first place. Could you please provide any resources for your answer? I would like to make sure I'm coding correctly.
SuperCoder Answered Fri 14th of September, 2018 03:53:55 AM

Hi Tanesha,


Thank you for your question.


As per NCCI edit, there are bundling conflict between both the CPT® codes 43249 and 43239; but a modifier can rule out the bundling conflict between both the codes. Since both the procedures include Esophagogastroduodenoscopy, so the possible way to distinguish between the performed services would be the location of biopsy and dilation.

·         If the area of biopsy is the same from where the dilation was performed, then you are advised to report CPT® code 43249 only.


·         If the esophagus was dilated and the biopsy was taken from another area, such as duodenum/stomach, then you can append modifier-59 (Distinct Procedural Service) with CPT® code 43239.


Kindly find the below reference. (page-12)



Hope this helps.


Tanesha Posted Fri 14th of September, 2018 08:37:50 AM
Thank you for your response.
SuperCoder Answered Mon 17th of September, 2018 00:23:36 AM

Thank you, happy to help.

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