tci Outpatient Facility Coding Alert - 2015 Issue 9

Reader Question: Use Modifier 59 When CMS Bundles the Procedure

Question:Our physician performed an EGD with guide wire dilation and also biopsy on a patient recently. How should I bill these sessions? Do I need modifiers on these codes? They are not bundled but have been denied in the past without modifier 59 because I was basically told these were in the same “family” and couldn’t be billed together. What should I do? Alabama Subscriber Answer: For the upper GI EGD and guide wire esophageal dilation, you should report code 43248 (Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator[s] through esophagus over...

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