# esophogeal dilation



## cherie33

Need help deciding between 43450 and 43453...from what I've read Savary dilators are wire guided...and the other bougies he used are specified...thoughts? 

After induction of general anesthesia with an oral RAE tube, the gastrointestinal (GI) Savary dilators were initially used to dilate the esophagus.  The smallest Savary dilator was begun at 33 French and serially increased up to 44 French.  Of note, the Savary dilators did not pass as smoothly as the subsequent bougie dilators.  Unfortunately, the smallest bougie dilator available began at 48 French.  Once dilation was completed using the Savary dilators up to 44, the 48 bougie dilator was passed without difficulty down through the esophagus and then serially increased in size up to an end dilation of 56 French.


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## 2618216km

43450 is the correct code. The difference between the two codes are if a guide wire was placed and used to dilate the esophagus. Savary dilators is a BRAND name of a bougie and documentation supports that this was dilated without a guide wire.
43450  
Dilation of esophagus, by unguided sound or bougie, single or multiple passes  
 The physician dilates the esophagus using an unguided dilator. The physician passes a dilator into the patient's throat down into the esophagus until the end of the dilator passes the stricture. A stricture is a decrease in the esophagus opening as a result of cicatricial (scar) contraction or a deposit of abnormal tissue. The dilator is withdrawn after it passes the stricture. This may be repeated several times to dilate the esophagus to an acceptable size


43453
Dilation of esophagus, over guide wire 
The physician dilates the esophagus by passing dilators over a guidewire. The physician uses a fluoroscope to place a guidewire into the patient's throat, down the esophagus, and into the stomach. A series of olive-shaped metal dilators (Eder-Puestow) are passed over the guidewire and withdrawn. The process is repeated until the esophagus is dilated to an acceptable size.


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