Gastroenterology Coding Alert

Because there are many different ways that a gastroenterologist can dilate an esophagus, theres an often confusing array of dilation codes from which to chose. The type of dilator used and whether an endoscope and/or a fluoroscope were employed during the procedure will determine which CPT codes should be reported. In addition, not all manipulation codes used to report a dilation include an endoscopy in their description, and that procedure may have to be reported separately if it is performed by the gastroenterologist.

Esophageal dilations are performed when there is a stricture or abnormal narrowing of the esophagus, states Jane Allaire, RN, CGRN, a nurse endoscopist at the National Naval Medical Center in Bethesda, Md. The stricture could be due to a variety of causes, including a tumor, prolonged use of a nasogastric tube or complications from gastrointestinal reflux disease.

Five Categories for Classifying Dilations

Although dilation procedures will vary due to the nature, size and location of the stricture, the most frequent methods for reporting esophageal dilations can be summarized in the following five categories:

1. Dilation by balloon of less than 30 mm diameter: The gastroenterologist performs an endoscopy to visualize the esophagus, and then a deflated balloon is placed through the scope and across the stricture, explains Allaire. The endoscope remains in place while the balloon is inflated to a diameter of less than 30 mm.

Code 43220 (esophagoscopy; with balloon dilation less than 30 mm diameter) or 43249 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of the esophagus less than 30 mm diameter) should be used to report this particular procedure, says Pat Stout, CMC, CPC, an independent gastroenterology coding consultant in Knoxville, Tenn.

Code 43249 includes an EGD (esophagogastroduodenoscopy) in its description, which means that it should be used when the endoscope passes the pyloric channel and extends down into either the duodenum and/or jejunum. Code 43220 includes an esophagoscopy in its description and is used when the endoscope passes the diaphragm but not the pyloric channel. The gastroenterologist may pass the endoscope all the way into the stomach, notes Stout, and then dilate the upper esophagus before removing the scope. In that case, code 43249 should be reported.

The standard practice is to code for the endoscopic family in which the gastroenterologist was able to advance the scope, she explains. If the scope was extended into the stomach and into either the duodenum or jejunum for reasons of medical necessity, then it is appropriate to report the work done [...]