# ??Flouro included for EGD w/ placement of esophageal stent??



## ErinGaillard (Mar 12, 2013)

Is flouroscopic guidance included with CPT 43256? The code description states, " includes stent insertion, guidewire placement, tumor dilation and stent deployment. The stent placement maintains an adequate opening to improve functional capability and predilation is included in these codes." It does not specifically state flouro is or isn't included, unless it is included in the predilation maybe? Any help is greatly appreciated!

The physician did order this to be done under flouro, and I have a radiology note of "XR flouro for OR/GI Lab Proc" with it being a chest xray.

The EGD note I'm coding reads as follows:

NAME OF PROCEDURE:
Esophagogastroduodenoscopy with placement of esophageal stent.

PREOPERATIVE DIAGNOSIS:
Dysphagia secondary to esophageal cancer.

POSTOPERATIVE DIAGNOSIS:
Distal esophageal mass.

DESCRIPTION OF PROCEDURE:
Informed consent was obtained. Timeout was called and the patient and procedure were verified. The patient was placed on her back. After administration of intravenous sedation with propofol and appropriate monitoring, gastroscope was introduced into the mouth, advanced into the esophagus and then into the stomach. The oropharynx contained respiratory secretions which were thick, and these were suctioned clean. The esophagus revealed a mass in the distal-most esophagus which was from about 41 cm to 45 cm, roughly 4 cm just above the gastroesophageal junction. This was the malignancy that was identified in the past. It was friable. The gastroscope was maneuvered through it into the stomach. Radiopaque markers were placed at the proximal and distal ends of the mass. A guidewire was then passed through the gastroscope into the stomach, and the gastroscope was removed. An esophageal stent (WallFlex 23 mm in diameter and 125 mm in length, partially covered) assembly was passed over the guidewire. After placing the stent in proper position, it was released. The rest of the assembly material was removed and gastroscope was reintroduced to confirm good placement. The stent was noted to be in good place. The whole procedure was done under fluoroscopic guidance. The patient tolerated the procedure well.


The radiology note reads:
ONE VIEW CHEST

Fluoroscopy utilized for Dr. X producing two fluoroscopic spot
images. This demonstrates deployment of a long esophageal stent of the
distal third esophagus and extending most likely into the proximal
stomach. There is smooth narrowing at the GE junction.




Thanks in advance,
Erin


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## bridgettemartin (Mar 20, 2013)

If you are using 76000-26 as your code, it is bundled into 43256 according to CCI edits.  If the radiologist is placing those markers, they should be able to bill out something.  But, as far as the professional services (interpretation), those would be bundled into 43256.


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