Gastroenterology Coding Alert

Question: How should I bill for a blind Foley extraction of esophageal coins? I thought that 74235 (Removal of foreign body[s], esophageal, with use of balloon catheter, radiological supervision and interpretation) would fit with modifier -52 (Reduced services) appended. My billing company thinks 43215 (Esophagoscopy, rigid or flexible; with removal of foreign body) or 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body) fit better. These are endoscopic codes, and I am uncomfortable using these codes because we do not use endoscopes.

Michigan Subscriber

Answer: This procedure is hard to code because it is rarely performed except on pediatric patients. Esophageal coins are classified as foreign bodies. A blind Foley extraction is the manual removal of a foreign body without the use of a scope. When this is done in a physician's office, it is billed as an E/M visit because there is no code for this procedure. If this is done in radiology, then it would be billed with 74235. Be sure to include a proper diagnosis code, such as 935.1 (Foreign body in esophagus).