Gastroenterology Coding Alert

Answer for Scenario 1: For Medicare, report only 43249 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus [less than 30 mm diameter]), because NCCI has bundled Maloney dilation into that procedure code.
 
 Answer for Scenario 2: Report only 43248 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with insertion of guidewire followed by dilation of esophagus over guidewire). Do not report 43453 (Dilation of esophagus, over guidewire) as a separate service, because it is included in the endoscopy code 43248.
 
 Answer for Scenario 3: Report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) and 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes). 
 
Tip: If you are still unsure of how to report these codes, refer to "NCCI 10.1 Edits Bundle Manipulations With EGDs" before you send out your next claim with the affected codes.