Gastroenterology Coding Alert

Question: Our gastroenterologist performed an endoscopy, and after introducing the scope through the mouth, he advanced the scope to the second part of the duodenum. He accomplished the upper GI endoscopy without difficulty.
 
He found a mild Schatzki ring (acquired) in the gastroesophageal junction. He successfully dilated it with a 50Fr Maloney dilator. He also found a small hiatus hernia. He examined the stomach and the duodenum, which were both normal. How should I code for this procedure?

Wyoming Subscriber

Answer: Use 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the endoscopy.
 
You should use 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes) for the Maloney dilation.
 
You may think that using modifier 59 (Distinct procedural service) is necessary for the dilation, but this is incorrect because the National Correct Coding Initiative does not bundle 43450 into 43235.
 
If the gastroenterologist performed the dilation with  a guidewire, use 43248 (- with insertion of guidewire followed by dilation of esophagus over guidewire).
 
If the doctor performed a balloon dilation, use 43249 (- with balloon dilation of esophagus [less than 30-mm diameter]).