Modifier Coding Alert

Question: Our gastroenterologist met a patient at our local hospital to perform a flexible esophagogastroduodenoscopy. Due to an irregularly shaped stricture, the physician needed to use a guide wire to pass two dilators through the esophagus. There were also visualization issues during the procedure, and the gastroenterologist used fluoroscopic guidance. Can I report the dilations and fluoroscopy separately from the esophagogastroduodenoscopy?

Ohio Subscriber

Answer: You cannot report the dilations separately from the esophagogastroduodenoscopy; Correct Coding Initiative (CCI) edits bundle guide wire dilations into esophagogastroduodenoscopies. For the procedure, report 43248 (Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator[s] through esophagus over guide wire).

Mind your surroundings: You can, however, code for the guidance with an assist from modifier 26 (Professional component). On the claim, include 74360 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and interpretation) for the fluoroscopy with modifier 26 appended to show that you are only coding for the professional portion of the service.

 

 

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