Gastroenterology Coding Alert

Question: Our physician performed an endoscopic PEG tube placement that required some extra work. After initial dilation through scope balloon dilation and the start of the procedure, the esophageal tract narrowed, and the gastroenterologist had to dilate it again, this time through blind bougie dilation. He didn't need to use an endoscope. Can I code the second dilation separately?


Connecticut Subscriber

Answer: Yes, but you should keep in mind that multiple-endoscopy payment rules apply.

Initial dilation: You should report the scope balloon dilation using 43249 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus [less than 30 mm diameter]).

Second dilation: You should report the blind bougie dilation using 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes).

You shouldn't expect full reimbursement for both procedures. The multiple-endoscopy payment rule states that payers will pay 100 percent for the higher-valued code and then the difference from the base family code for the lesser-valued code. The reasoning for this is that payers believe that both codes include the base procedure, so you shouldn't receive payment for that twice.

Don't forget: Code the PEG tube placement with 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube).