Forum - Questions & Answers

Oct 4th, 2010 - rphelps 615  1 

Multiple endoscopies

How do I bill 43239 and 43258. Do I use a 59 or 51 and on which?

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Oct 5th, 2010 - Codapedia Editor 1,399 

multiple endocsocpies

No bundling issues between 43239 and 43258
43239 has 9.02 RVUs and should be submitted first, no modifier
Medicare does not require the 51 modifier on the second procedure, but some payers might.

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Oct 5th, 2010 - rphelps 615  1 

multiple endoscopies


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Oct 5th, 2010 - jschmutz   323 

43239 and 43258

Just because there isn't a bundling issue with 43239 and 43258 doesn't mean it is appropriate to bill this code combination together.

Why are they doing a biopsy followed by ablation? The biopsy would be inherent to the procedure being performed for removal unless done at a separate site, encounter, incision, etc. If they are removing the same lesion that they are biopsying then it would not be appropriate to report both procedures.

Patients often require more than one upper GI scope. For example, while performing an EGD (43235), the surgeon also may take a biopsy (43239) and remove a lesion by snare technique (43258).

Codes 43239 and 43258 are payable as long as different procedures are performed at different sites. The different site does not have to be in another section of the stomach, duodenum or esophagus; a separation as small as 1 centimeter constitutes a separate site.

Because the biopsy and lesion removal are from the same endoscopic family (i.e., both are upper GI procedures, not esophagoscopies or colonoscopies, for example), normal multiple-procedure rules do not apply. Instead, billing for these procedures is guided by Medicare’s multiple-endoscopy rule, which states, “For multiple endoscopic procedures, use the full value of the highest valued endoscopy plus the difference between the next highest and the base endoscopy.”

This means that 43258 would be listed first, followed by 43239. The EGD (43235) is not listed because it is bundled to both of the other procedures, it remains an important factor in determining the correct billing amount because it is the base code for this family of endoscopic procedures.

Although 43258 and 43239 are not bundled in the national Correct Coding Initiative, modifier -59 (distinct procedural service) should be appended to the lesser procedure (43239) to indicate that the procedures were performed on different sites.

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Oct 6th, 2010 - Codapedia Editor 1,399 

43239 and 43258

Many thanks for the correction and explanation. It is very much appreciated.

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