Gastroenterology Coding Alert

Question: Our gastroenterologist performed a dilation of the esophagus over a guidewire. How do you report this procedure?

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Answer: Sometimes your gastroenterologist might need a guidewire for performing a dilation of the esophagus. A situation that warrants it might include a tight stricture that your gastroenterologist might not be able to pass through with an endoscope. In such a scenario, the extent to which your gastroenterologist is passing the endoscope might help you determine the right procedural code.

If your gastroenterologist is performing a guidewire insertion and dilation of the esophagus to only examine the esophagus, then you have to report the procedure with 43226 (Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation over guide wire). But if your gastroenterologist is performing the guidewire dilation of the esophagus to examine the esophagus, stomach and either the duodenum and/ or jejunum, then you need to report the procedure with 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).

In some rare circumstances, your gastroenterologist might dilate the esophagus over the guidewire without the use of an endoscope. In such a scenario, you have to report the procedure with 43453 (Dilation of esophagus, over guide wire). However, this procedure will require fluoroscopic guidance. You have to report this with 74360 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and interpretation) with modifier 26 (Professional component) to indicate that your gastroenterologist only performed the supervision and the interpretation of the procedure.