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EGD-related: CPT 43249

Melanie Posted Tue 23rd of March, 2010 13:51:11 PM

I have an interesting scenario that a doctor wanted to throw here via me...

He has a patient who has no history of having Schatzki's Ring - which traditionally patients with that - will require a balloon to open so they can pass the scope through and into the stomach.

His patient - in question: significant for dysphagia upon viewing the esophagus - structurally speaking.

Patient also has acute gastritis and GERD.

When I asked him if the patient had a 'ring', he stated that by site, nothing was seen to be considered a 'ring' but, the dysphagia was so significant that he had to open the esophagus more in order to pass through the pylorus..

would dysphagia be enough to qualify for the balloon?

SuperCoder Answered Tue 23rd of March, 2010 14:19:39 PM

I have checked the LCD (E.g. Virginia) and found that dysphagia do supports 43249, so I think that this would qualify for the CPT 43249. Also do check your LCD's.

Melanie Posted Tue 23rd of March, 2010 14:53:55 PM

re: LCD's... believe me I do - but our region's site doesnt always work and keeps coming up with broken links - which is why I posted it here first while I go back to the website periodically to see if I can pull them up... 8-)

SuperCoder Answered Wed 24th of March, 2010 05:43:26 AM

Ok I have also checked the Crosslink and found that dysphagia, do supports 43249.

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