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SuperCoder Posted Sat 24th of March, 2012 18:16:04 PM

If the Gastro did an EUS stomach(43259) and EGD(43235) I understand that they can't be billed together but what's the correct billing if the findings were adrenal tumor. Shouldn't I bill for the EGD under this circumstances

SuperCoder Answered Sun 25th of March, 2012 14:46:07 PM

Both EUS stomach(43259) and EGD (43235) can't be billed together, as you said. CPT 43235 code descriptor also indicates that it's a separate procedure. There are also various CPTs indicated by utilization of various methods for removal of tumors along with EGD.
43250-EGD with removal of tumors by hot biopsy forceps
43251-EGD with removal of tumors by snare technique
43258-EGD with ablation of tumors not amenable to removal by hot biopsy forceps, bipolar cautery, or snare technique.
If it relates any of above, then you can bill one of them. But all the above three procedures have lower RVUs than CPT 43259 (EUS stomach). Therefore, you should only bill CPT 43259. There is no specific CPT for EGD/EUS with adrenal tumor.

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