tci Outpatient Facility Coding Alert - 2016 Issue 2

Reader Question: Can 43235 and 43220 Be Bundled Together?

Question: The patient was admitted for a diagnostic EGD (43235). Preoperative diagnosis indicates dysphagia and history of benign esophageal stricture. The gastroenterologist wrote in her report, “Found esophageal stricture at 37 cm and scope would not pass. Dilation of distal esophageal with #16.5 and #18 hydrostatic balloon. Then proceeds to stomach and duodenum.” She wants to bill 43235 and 43220, but I heard a CCI edit is in place for this combination. Do you have any suggestions on how we can be paid for both services performed? Minnesota Subscriber Answer: The appropriate code would be 43249...

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