EGD w/ snare bx

I can't answer a question brought by our surgeon. He is doing an EGD, 43235, diagnostic, but once he gets in there does a 43251, removal by snare. the second he says is more difficulty but has less rvu value, and less reimbursement. He wants to bill the first/diagnostic code because of this. Any thoughts? this is not my usual area, so I'm not sure. I am assuming because the 43235 is a separate procedure we can't bill both...but???

diagnostic

You never bill the diagnostic scope when a therapeutic scope is performed at same session. (CCI General Policy-Medicare). The diagnostic becomes bundled into the therapeutic. You do not code by reimbursement, you code on what was done and coding rules. The note in CPT prior to this code accurately describes this principal.

Re: diagnostic

This is what I was trying to tell him, but he insists the 43251 should have higher reimbursement than the diagnostic, because, he did all the work of the diagnostic, AND the "extra" work for the snare. He is wanting me to tell him why the 43251 pays less. This is what I can't answer for him.