Gastroenterology Coding Alert

Question: My gastroenterologist's notes indicate that he performed an upper gastrointestinal endoscopy (EGD), during which he used a guide wire and "Savary" dilators. What are "Savary" dilators, and which code should I report for this encounter?


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Answer: A "Savary" dilator is the brand name for a dilator that can be passed over a guide wire during EGDs, especially when strictures become too tight ("American" is another brand name for a similar dilator also used for the same purpose).

There are two codes to represent an EGD with Savary dilators. Look back at the operative notes and check whether the gastroenterologist was able to visualize the entire upper GI tract (esophagus, stomach, and duodenum) or if the stricture only allowed visualization of the esophagus.

If the gastroenterologist visualized the stomach and duodenum at any point before or after the Savary dilation, report 43248 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with insertion of guide wire followed by dilation of esophagus over guide wire).

If the gastroenterologist could not pass the scope beyond the stricture and only visualized the esophagus, report 43226 (Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation over guide wire).

Exception: Though it is rare, the gastroenterologist may sometimes send the dilator over a guide wire without using an endoscope but rather a fluoroscope to insert the wire. If this occurs, report 43453 (Dilation of esophagus, over guide wire).