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Gastroenterology

Thomas Posted Tue 02nd of September, 2014 17:02:14 PM

A patient had an EGD with injection and BiCAP of AVM and Biopsy.
I billed Medicare 43255 first CPT code and 43239-59 second CPT code, however Medicare added modifier 59 to 43255 and 59 plus 51 to second CPT 43239. Should I filed claim as Medicare EOB was printed?
Thank you - Oklahoma Subscriber

SuperCoder Answered Wed 03rd of September, 2014 07:32:28 AM

Thanks for your question. If you check CCI edits 43255 is a column 2 code for 43239 and requires the use of a modifier. It does not indicate that 43239 needs a modifier, however you should check payer guidelines to determine if they require a modifier when billing this combination of codes. If Medicare added these two codes on your eob, more than likely this is the way that they would like for you to bill these codes. See attached link for a supercoder article for additional information. http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/multiple-egds-dont-overlook-your-43239-billing-opportunities-article

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