Gastroenterology Coding Alert

Question: Our physician performed an esopha-goscopy using a guide wire to ensure proper placement of a bougie dilator. What is the proper code?

North Dakota Subscriber Answer: At times, gastroenterologists need to use guide wires with bougie dilations, usually when strictures either become too tight or take on irregular shapes. When coding this type of procedure, consider the exact sequence of events the physician undertook in placement of the bougie. After formulating a timeline, use whichever of these codes best fits your scenario:
 
 43248 - Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with insertion of guide wire followed by dilation of esophagus over guide wire
   43226 - Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation over guide wire. Though not a common course of action, physicians will sometimes send a dilator over a guide wire without using an endoscope. The appropriate code for this is 43453 (Dilation of esophagus, over guide wire).
 
If the physician uses a fluoroscope during this procedure, first report 43453, then report the fluoroscopy, 74360 (Intraluminal dilation of strictures and/or obstructions [e.g. esophagus], radiological supervision and interpretation) with modifier -26 (Professional component) attached.
 
FYI: A quick check of your physician's notes can save you time when coding endoscopic dilations using a guide wire. Endoscopic procedures are easy to spot by the use of the words "Savary"or "American," two common guide-wire dilator brand names. If you find either of these keywords in the doctor's notes, be on the lookout for a guide-wire dilation.