Thomas Posted Wed 27th of April, 2016 21:16:49 PM
What CPT codes and in what order, including modifiers would be used in
filing insurance (Medicare) for following procedures done?
EGD with esophageal balloon dilation and esophageal Maloney Bougie and
biopsies. Physician said the EGD with dil and Bougie were two separate
SuperCoder Answered Thu 28th of April, 2016 04:34:36 AM
Thanks for your question. As per the provided documentation, you should report following codes:
1. 43249 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter))
2. 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple)
Thomas Posted Thu 28th of April, 2016 17:18:58 PM
EGD with biopsies and esophageal dilation with BOTH Maloney bougie and esophageal balloons.
Thank you for your answer. In talking with the physician he explained further that he first performed the Maloney dilatation to open the stricture because he could not get the endoscope to go through and then once the stricture was open he passed the endoscope down to balloon dilate the esophagus then thirdly he took biopsies. Maloney bougie and esophageal balloon dilatation were two separate tasks performed. Is there a modifier I can use and send report?
Also she was a Medicare patient if that helps.
Thanks again for all the help.
SuperCoder Answered Fri 29th of April, 2016 03:36:34 AM
Thank you so much. It is really a good discussion.
As we know the patient has stricture of esophagus and physician has done dilation of esophagus twice; first Maloney dilation and then balloon dilation. So instead of reporting two codes we reported only one code (i.e. 43249), because of these reasons:
1. There is CCI edit between codes 43249 and 43450. Code 43450 is a column 2 code and modifier is not allowed. So we cannot report 43450.
2. As per guidelines, if physician has used two different methods to treat a single condition (i.e. esophageal stricture), we can bill only one method.
Please feel free to write to us if you have any concern.