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Gastroenterology Coding Alert

You Be the Coder:

Can You Combine 43235 and 43220 In A Claim?

Published on Thu May 05, 2011

Question: The patient is admitted for diagnostic EGD (43235).Preoperative diagnosis indicates dysphagia and history of benign esophageal stricture. The gastroenterologist writes in her report, "Found esophageal stricture at 37 cm and scope would not pass. Dilation of distal esophageal with #16.5 and #18 hydrostatic balloon. Then proceeds to stomach and duodenum." She wants to bill 43235 and 43220, but I heard a CCI edit is in place for this combination. Do you have any suggestions on how we can be paid for both services performed?Minnesota SubscriberAnswer: The appropriate code would be 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]).Background: When the physician's documentation specifies that he placed a deflated balloon dilator through the endoscope and gradually inflated the dilator to open the stricture, you can choose from either 43249 or 43220 (Esophagoscopy, rigid [...]
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