Beat the Brand-Name Soup to Create Perfect GI Dilation Claims
Published on Thu Jun 28, 2007
Discover how to code these 4 distinct dilation types
If you-re staring endlessly at your physician's notes in an effort to decipher terms such as -Maloney,- -Hurst- and -Savary,- then you probably need to broaden your dilation coding lingo.
Focus: To determine which code you need, you must understand the difference among these dilation techniques.
What happens with dilations: The gastroenterologist will evaluate the stricture and decide between several types of dilators. The dilator choice depends on the stricture's size and characteristics, the physician's judgment, and the patient's history. 1. Isolate These Bougie Dilator Codes Gastroenterologists perform some dilations with endoscopes and others without endoscopic guidance. In the latter, which you would code as manipulations, the physician may use an endoscope to visualize the stricture but remove it before he does the dilation. Also, he may use a fluoroscope to guide the dilator's placement.
What to look for: When reviewing the physician's notes, look for the term -bougie,- -Maloney- or -Hurst.- Bougies are flexible dilators available in increasing thicknesses. A physician inserts these dilators into the esophagus in successively increasing diameters to open a stricture gradually. The bougie diameter can be stated in millimeters or in -french.- Note: French is another scientific measurement format. In other words, 1 mm = 3 Fr. The physician may also refer to a bougie based on its shape as -Maloney- or -Hurst.-
Bougies defined: Physicians use bougie dilators when they know the stricture type, site and size from a previous endoscopic procedure or barium swallow x-ray. These strictures tend to be less tight than those requiring directed endoscopic manipulation. Whenever the operative notes articulate these circumstances, start looking to 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes).
You should report 43450 for the insertion of a dilator or series of dilators. If the gastroenterologist performs an endoscopy before the dilation, you should report it separately, says Shonna Heath of North Country Gastorenterology in St. Littleton, N.H.
Example: The physician performs an esophagogastroduodenoscopy (EGD) with biopsy (43239) before inserting a Maloney dilator. Report 43239 first because it has a higher relative value, and expect 100 percent reimbursement from Medicare. Report 43450 with modifier 51 (Multiple procedures) appended and expect 50 percent of the standard fee if you follow Medicare's multiple-procedure rules (see -Simplify the Multiple- Endoscope Family Rule With This Expert Advice- on page 45 for more information on the multiple-procedure rule).
Don't miss: You can code for fluoroscopic guidance when the physician uses a fluoroscope during the procedure, says Jan Simms, CPC, CGCS, coder for Birmingham Gastro Associates PC in Alabama.
For the above example, you should report 74360 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and interpretation) [...]
