Gastroenterology Coding Alert

Here's how to break down methods of dilations into five easy categories

Your gastroenterologist can dilate a patient's esophagus in several different ways, making several CPT codes applicable, but pinpointing two vital ingredients will get your esophageal dilation claims paid every time.

To ensure the appropriate choice, focus on:

• the type of dilator the gastroenterologist used
• whether he used an endoscope and/or fluoroscopy. Did you know? Your gastroenterologist will perform an esophageal dilation to treat a stricture or abnormal narrowing of the esophagus, which could be caused by a variety of conditions, such as a tumor, prolonged nasogastric tube use or complications from gastroesophageal reflux disease (GERD). You can summarize the most frequent methods for reporting esophageal dilations into five categories: 1. Use 43220, 43249 for Dilation by Balloon of < 30-mm Diameter If your physician's notes include a dilation by balloon of less than 30-mm diameter, you can automatically look to two codes:

• 43220--Esophagoscopy, rigid or flexible; with balloon dilation (less than 30-mm diameter)

• 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). Example: A gastroenterologist performs an endoscopy to visualize the esophagus and then places a deflated balloon through the scope and across the stricture. The endoscope remains in place while the physician inflates the balloon to a diameter of less than 30 mm. If the gastroenterologist passes the endoscope beyond the diaphragm but not the pyloric channel, you should report 43220. But if the physician does pass the pyloric channel--regardless of where the esophageal stricture is located--use 43249.

Watch out: You cannot report 43249 as well as 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes) without confronting a Correct Coding Initiative edit, says Connie Pitman, a coder at Lubbock Digestive Disease Associates in Lubbock, Texas. This edit carries a "0" modifier indicator, which means you cannot bill the codes together under any circumstances. 2. Dilation Over Placed Guidewire Means 2 Codes Second, your gastroenterologist may perform an endoscopy to visualize a stricture and to pass a guidewire into the stomach. He then removes the scope, leaving the guidewire in place, and threads the dilator (or a series of them) with a lumen onto the wire and advances it until the dilator reaches the stricture. Your physician may refer to this type of dilator as American or Savary type.

What to do: When your physician performs this type of dilation, you should report 43248 (...with insertion of guidewire followed by dilation of esophagus over guidewire), which covers both the guidewire insertion and the dilation. If the gastroenterologist doesn't pass the endoscope into the stomach to place the guidewire, instead use 43226 (... [...]