CPT® 43235

Medicare denies CPT® 43235 used with ICD 9- 530.89 and 553.3 stating medical necessity. However it looks like these DX codes supports medical necessity .. Please help me to figure out whether this code combination is wrong.

Oct 14th, 2015 - rphelps 615 1

re: CPT® 43235

Are you coding any other codes along with 43235? Is the date of service after 10-1? These codes should justify and endo getting paid.6ta3z5

Oct 15th, 2015 - Ruvi 5

re: CPT® 43235

This is what we billed .

05/14/2015 99223
05/15/2015 43235
05/18/2015 99238

Oct 14th, 2015 - LBAROGIANIS 250

re: CPT® 43235

this has some info: http://www.asge.org/uploadedFiles/Members/Practice_Management/2015%20Medicare_Physician_Payment_Presentation_Slides_FINAL_11-10-2014.pdf

What state are you from? Try looking up the LCD for CPT® 43235 on your MAC website. They usually have alot of good information.

Oct 15th, 2015 - rphelps 615 1

re: CPT® 43235

6ta3z5 has nothing to do with my response.

Oct 15th, 2015 - Ruvi 5

re: CPT® 43235

Thank you so much