Gastroenterology Coding Alert

Question: My gastroenterologist saw a patient who has a non-passable stricture at the pylorus. Using a 5-mm graded CREE dilator, the physician was able to inflate the stricture up to 16.5 mm, after which the scope passed easily into the second portion of the duodenum. The folds in the second portion of the duodenum appeared scalloped. Therefore, the physician obtained small bowel biopsies. What procedure code should I report?

California Subscriber

Answer: You would use 43245 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with dilation of gastric outlet for obstruction [e.g., balloon, guidewire, bougie]) for the dilation of the pylorus. Your diagnosis code to link to this procedure code would depend on what the pathology report indicates.

In addition, you should report 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple) for the biopsy of the duodenum. Link this code to ICD-9 code 537.0 (Acquired hypertrophic pyloric stenosis).

Important: Sequence 43245 first because it has the higher relative value unit (RVU), and then 43239. Don't worry about Correct Coding Initiative edits. You can report these codes together, but be careful: Your payer may require a modifier (such as 59, Distinct procedural service).