General Surgery Coding Alert

Question: During an esophagoscopy procedure, the surgeon performs balloon dilation to address an obstruction prior to placing a stent. Should we report this as 43214 for the balloon dilation and 43212 for the stent placement?

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Answer: No, reporting 43214 (Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)) and 43212 (Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)) together for this case amounts to unbundling.

Do this: Report the procedure using 43212 alone. Although the code does not describe “balloon” dilation, it does specify that the procedure includes pre- and post-dilation, when performed. You should use the comprehensive code to describe your surgeon’s work.

Proof: National Correct Coding Initiative (NCCI) edits bundle 43214 as a column 2 code for 43212 with a modifier indicator of “1,” meaning that you cannot override the edit pair under any circumstances.

Also: Although 43220 (Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)) also mentions balloon dilation, you should not use this code because it does not include stent placement.