43249 with 43236

after balloon dilation the provider injects triamcinolone into the stricture to improve function. Is it appropriate to unbundle and bill both codes or do we bill for the balloon dilation only?

Apr 8th, 2019 - ChrisW 256 1

re: 43249 with 43236

By doing an NCCI edit on Find-A-Code with these two codes you will only get paid for the 43249.

NCCI Edit results: Edit exists with 43249. 43236 is a Column 2 code. If both 43249 and 43236 are submitted, only 43249 will be paid. To view the rational see the NCCI Policy manual Chapter VI Digestive System - It would not be appropriate to unbundle these codes.

Apr 10th, 2019 - AMat 2

re: 43249 with 43236 response

Thank you for your response. There is new data showing that triamcinolone injection into strictures such as these improves function; that is for patients who have undergone an esophagectomy. We did check with the major payers to see if there was any policy information but found none. I found the article interesting just the same. Here it is if anyone would be interested.
https://www.ncbi.nlm.nih.gov/pubmed/30181533