Gastroenterology Coding Alert

Question: Our physician performed an EGD with biopsy before the insertion of a Maloney bougie dilator. Fluoroscopic guidance was used during the procedure. How should I code this?

North Carolina Subscriber

Answer: No matter how it is coded, Medicare's multiple-procedure rules prohibit 100 percent reimbursement in this situation. Report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) first because it has a higher relative value unit; you should receive full payment from Medicare for the esophagoscopy. For the Maloney dilation use 43450* (Dilation of esophagus, by unguided sound or bougie, single or multiple passes) and for the fluoroscopy use 74360-26 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and interpretation; Professional component) for the physician's interpretation. Reimbursement will be 50 percent of the standard fee here, also.