Gastroenterology Coding Alert

Question: Our GI recently performed an esophageoduodenoscopy with biopsies and esophageal dilation with balloon/Bougie. What CPT® codes would be the most appropriate for the procedures? In what order should the codes be listed, and is there any modifier to be used?

Oklahoma Subscriber

Answer: The correct code for reporting the esophagoduodenoscopy (EGD) with biopsies would be 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple). Please note that you will report 43239 only once even if multiple biopsies were taken in the session. Moreover, according to CCI edits, you should not bill the biopsy (43239) with endoscopic mucosal resection (43254, Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection) for the same lesion.

For reporting EGD with esophageal dilation with balloon/bougie, you have a choice of codes. For balloon dilation, you can either report code 43249 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus [less than 30 mm diameter]) or 43233 (Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon [30 mm diameter or larger] [includes fluoroscopic guidance, when performed]) depending on the size of dilation.

For bougie dilation, you can either use 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes) or 43248 (Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator[s] through esophagus over guide wire).

If fluoroscopic guidance was used, you can report that with code 74360 (Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation), except with 43233.

CCI edits shows no bundling in between these codes. So, you can bill them without any modifier. Also, you should list the codes according to the decreasing RVU order.

Therefore the claim can look like this:

1. 43249 x1 (highest non-facility 2015 RVU: 31.03)

2. 43239 x1 (2015 RVU: 11.48)

3. OR 43233 (2015 RVU: 6.91)