Finding Out About Bundling Edits

June 1, 2007

Could you please tell me the rule for billing code 43235 along with 43260?

Question: Could you please tell me the rule for billing code 43235 along with 43260?

Answer: The place to look is CMS’ National Correct Coding Initiative Edits for Physicians.

When I look at the column 1/column 2 edits for the digestive series, I see it lists 43260 in column 1 and 43235 in column 2. That means they typically would be bundled.

Bill the 43260 and only use a modifier (probably -59) if there truly is some unusual circumstance.

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