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Gi EGD with Biopsy and balloon dilation

Thomas Posted Wed 28th of October, 2015 11:39:26 AM

Saw the answer to previous question and understand no modifier to be used when billing following CPT codes. When Medicare processes claims with codes:
43249
43239
they show CPT codes listed with modifiers as 43249
43239 59 51
Confused as to use modifers or leave off?

SuperCoder Answered Thu 29th of October, 2015 07:07:30 AM

CMS CCI edits do not show any bundling or modifier requirement in between these codes. Still, you can append modifier -51 with CPT 43239 to indicate the multiple procedure as the RVU value of CPT 43239 is lesser than CPT 43249.

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