Gastroenterology Coding Alert

Question: Our gastroenterologist recently used a Maloney bougie dilator during an EGD with biopsy to overcome a stricture. He also made use of fluoroscopic guidance for the procedure. How do I report this procedure that our gastroenterologist performed?

Cincinnati Subscriber

Answer: You will have to report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) to report the EGD with biopsy. The use of the dilator can be reported with 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes). For the fluoroscopic guidance that your gastroenterologist used during the procedure, you can report 74360 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and interpretation). Append modifier 26 (Professional component) to 74360 if your gastroenterologist was only involved with the interpretation of the fluoroscopy procedure.

Note that there are no CCI edits for using 43239 and 43450 together. However, Medicare's multiple procedure rules will apply for reimbursement of these two procedures when they are performed during the same operative session. So 43239 will be paid at 100 percent as this carries a higher RVU while the 43450 and 74360 will be paid out at 50 percent of the standard fee.