General Surgery Coding Alert

Question: During an upper GI endoscopy, the surgeon had difficulty passing the dilators and so instead used guidewires with endoscopic guidance. Does this procedure earn 43233?

Texas Subscriber

Answer: No, reporting 43233 (Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)) would not be appropriate for the procedure you describe, because the surgeon did not complete the balloon dilation.

Instead, you should submit a code that describes the guidewire. In that case, the correct code depends mostly on how far the surgeon advanced the scope.

Likely: For an esophagogastroduodenoscopy (EGD), you’ll probably need to turn to 43226 (Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire) if your surgeon visualized only the esophagus and possibly the proximal stomach. If the surgeon advanced the scope beyond the pyloric channel, you should instead turn to 43248 (Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire).