Ramona Posted Mon 24th of August, 2015 08:23:22 AM
We had a patient that was taken to OR as emergency with hematemis and the Dr. did EGD with banding of esophageal varices 45344. Before the patient left the OR but after the EGD was completed and he was being awakened from anesthesia, the patient popped the bands off and began bleeding again. He then had to be put under anesthesia again and the Dr. did an esophagoscopy with banding of esophageal varices 43205. This is a Medicare patient can you tell me which modifier I should use to get paid for both procedures?
SuperCoder Answered Tue 25th of August, 2015 02:54:28 AM
Well, 45344 is invalid code. For EDG use out of code series 43235-43270. Correct code is 43244. CPT 43205 cannot be billed with CPT 43244 as per CCI edits. Even non of the modifier is not indicated as per guidelines. Because of same DOS, it will be denied. So, you can bill only one procedure. Hope it helps!