Gastroenterology Coding Alert

Question: Our physician performed an endoscopic PEG tube placement that required some extra work. After initial dilation through scope balloon dilation and the start of the procedure, the esophageal tract narrowed, and the gastroenterologist had to dilate it again, this time through blind bougie dilation. He didn’t need to use an endoscope. Can I code the second dilation separately?

Codify Subscriber

Answer: Yes, but you should keep in mind that multiple-endoscopy payment rules apply.  

Initial dilation: You should report the scope balloon dilation using 43249 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)).

Second dilation: You should report the blind bougie dilation using 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes).

Don’t forget: Code the PEG tube placement with 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube).