2 EGD's on same date

Good morning all!
I have a question that I am sure most have run across before. I would like to know what you do in a circumstance like this. Patient had an EGD done in the morning (43235) for GI bleed but when doing the procedure they did not see where the bleed was coming from and later in the day began bleeding again so they did another EGD this time to control the bleed (43255). CCI edits say we can't bill the two on the same day. How would you handle this billing? Only bill for the 43255? Thanks so much for your help!

Cindy Wensmann, CPC
Cardiac Surgery/Gastroenterology Coding Specialist II
CentraCare Health
320-229-4916 Ext. 71627
wensmannc@centracare.com

Comments

  • edited May 2017
    If this were medicare I would try the new modifier XE. Otherwise you are
    going to be stuck with -59 which will get denied and you will have to
    appeal. 
  • I did add the XE mod. I am being told by our ins analyst that they are not able to appeal this. Is this a correct statement? Thanks!

    Cindy Wensmann, CPC
    Cardiac Surgery/Gastroenterology Coding Specialist II
    CentraCare Health
    320-229-4916 Ext. 71627
    wensmannc@centracare.com
  • edited May 2017
    I would definetely challenge this as it was two separate encounters. 
  • I would try modifier 76. repeat procedure same physician.


    Jill Stuhmer
    Billing Manager

    William Silver MD & Eric Tatar MD PC
    Svetlana Korenfeld MD
    2 Medical Park Drive, suite 14
    West Nyack, NY 10994
    845-362-3300

  • edited May 2017
    Modifier -76 would not apply as they were different procedures at each encounter
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