You Be the Coder: Is Fluoroscopy Separate With EGD and Dilation?

Question: The physician performed an EGD with biopsy before inserting a Maloney bougie dilator. He used fluoroscopic guidance during the procedure. What are the appropriate CPT codes for this?

North Carolina Subscriber

Answer: No matter how you code this service, Medicare’s multiple-procedure rules prohibit 100 percent reimbursement for all the procedures in this situation.

Report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) first because it has a higher relative value. You should receive full payment from Medicare for the esophagoscopy.

For the Maloney dilation, use 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes).

Under new CMS rules beginning Jan. 1, you may report the fluoroscopy, as described by 74360 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and inter-pretation), as an integral, related service, in either a hospital outpatient or ASC setting.