CODING CORNER: Hone Your Device Savvy for GI Dilation Coding

Know when to report scope, balloon and guidewire codes

Upper GI dilation procedures don’t always call for digestive manipulation codes--you may need endoscopy codes instead or scope codes in addition. Check out this breakdown to find out which procedure requires which GI code.
No Scope? Opt for Manipulation Code
If the physician does not use a scope during the upper GI dilation, you should report a manipulation code (43450-43458) only, says Margie Pfaff, CPC, corporate compliance analyst for Wisconsin’s Medical Associates Health Centers. To determine which of these codes is appropriate to the circumstances, carefully check the documentation.
Look for key terms: When reviewing the physician’s notes, look for the descriptors “bougie” (which is a type of flexible dilator) and “Maloney” or “Hurst” (which refer to the shape of the bougie). If you encounter any of these terms, you should probably use 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes).
Achalasia dx provides another hint: Achalasia causes spasm and lack of relaxation of the lower esophageal sphincter (LES) muscle. Therefore, physicians must often use a larger, balloon-type dilator to treat this problem. You can report dilations of this type (without an EGD) using 43458 (Dilation of esophagus with balloon [30 mm diameter or larger] for achalasia).
Beware the Unusual Method
In cases where the physician inserts a dilator over a guidewire without using a scope, you should report 43453 (Dilation of esophagus, over guide wire), says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga. Often, however, the physician will use an endoscope to place the guidewire, which calls for different coding (see “Turn to 43226, 43248 for Guidewires” below).
Key term: When you see the terms “Pustow dilator” or “Pustow rod,” you can be fairly sure that 43453 is the correct code.
For the rare transgastric intraoperative retrograde (reverse direction) dilation using a balloon or dilator without a scope, you should apply 43456 (Dilation of esophagus, by ballon or dilator, retrograde). For endoscopic balloon dilations, your code choice will differ (see “Balloon Dilator Calls for 43220 or 43249,” below).
Don’t Leave Out Visualization
If the doctor performs an endoscopy for visualization or other purposes (such as biopsy) prior to dilation using a bougie, you may report the scope separately while still calling on 43450-43458 to describe the dilation itself, Pfaff says.
“Most frequently, the physician will perform a diagnostic EGD to evaluate the GI tract to the duodenum,” Pfaff says. “After assessing the entire upper GI tract, the physician will remove the scope.”
Example: The physician performs a diagnostic EGD (43235, Upper gastrointestinal endoscopy including esophagus, stomach, and either [...]

- Published on 2005-11-21