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Modifier 51 use

Tammy Posted Tue 24th of February, 2015 18:26:11 PM

When billing an EGD with dilation of esophagus and bx of gastric ulcer I would list 43248 first and 43239 2nd. Is it appropriate to attach modifier 51 to 43239, or is this unneccessary? Is modifier used on 2nd and 3rd CPT codes anymore?

SuperCoder Answered Tue 24th of February, 2015 22:50:56 PM

Thanks for your question. Per CCI a modifier is not needed when billing 43239; Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple and 43248; Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire. There are some procedures that require modifiers to be added due to bundling issues. You should check CCI and your payer policies to determine if they follow CCI guidelines or if the payer has its own guidelines for billing multiple procedures. Some payers require a modifier 51 to be appended to additional procedure and there are some payers that automatically take the multiple procedure reduction. Hope this helps.

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