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EGD/w dilation 43248 and 74360

Susan Posted Wed 27th of June, 2018 18:15:51 PM
Is anyone else billing 74360-26 with 43248. Some time ago I thought that 74360 could not be billed 43248 but there is another coder charging 74360-26 and it looks like we are getting a small reimbursement and taking the insurance adjustment. Just want to know if anyone else is billing for that.
SuperCoder Answered Thu 28th of June, 2018 02:39:26 AM

Hi Susan,

As per the CPT code 74360, this code reports only the radiological supervision and interpretation required in performing this procedure. 

Another common use of fluoroscopy in gastroenterology is with esophageal dilations, which are performed when there is a stricture or abnormal narrowing of the esophagus. Fluoroscopy helps determine where the dilator is going, Overholt explains. It can also help direct the guidewire. If fluoroscopy is used with either an esophagoscopy with balloon dilation (43220) or esophagoscopy with dilation over a guide wire (43226), CPT 2001 states that 74360 should be used to report the fluoroscopy. There is no CPT cross reference, however, for the related esophagogastroduodenoscopy (EGD) procedures EGD with balloon dilation (43249) and EGD with dilation over a guide wire (43248). Nevertheless, the same code, 74360, should be billed if fluoroscopy is performed with either of these procedures. 

Code 74360 should also be used whenever fluoroscopy is used with an esophageal dilation, says Overholt. Other dilation codes that might be reported in combination with fluoroscopy code 74360 include the non-endoscopic manipulation codes 43450 (dilation of the esophagus, by unguided sound or bougie, single or multiple passes) and 43458 (dilation of the esophagus with balloon [30 mm diameter or larger] for achalasia).

For further reference please consider the following link:

Hope this helps!

Susan Posted Mon 02nd of July, 2018 17:47:40 PM
I read a few of the procedure reports and they did not mention that fluoroscopy was performed. Would the fact that the physician used the fluoroscopy need to be in the report in order to bill for the 74360? One coder has been using the 74360 and it is not indicated in the report.I have not been billing for it for that very reason. Please clarify, thanks
SuperCoder Answered Tue 03rd of July, 2018 01:26:21 AM

Hi Susan,

It is definite that the clinical documentation should mention the use of fluoroscopy, only then is the code payable. In addition, the gastroenterologist also can report the use of the fluoroscope separately if he or she does the supervision and interpretation. If a gastroenterologist uses a fluoroscope, 74360 (intraluminal dilation of strictures and/or obstructions [e.g., esophagus] radiological supervision and interpretation) with modifier -51 attached also should be reported. Reimbursement for the fluoroscope will be 50 percent of the standard fee because the Medicare multiple procedures rules apply. In another scenario, the gastroenterologist may use a fluoroscope to visualize the placement of the guide wire. Code 74360 should be used to report the supervision of the fluoroscopy, and reimbursement should be 100 percent of the standard fee because this is the higher-valued procedure. The dilation code 43453 should have modifier-51 attached, and reimbursement should be 50 percent of the standard fee because the multiple procedures rules apply.

Hope this helps!


Susan Posted Tue 03rd of July, 2018 09:54:24 AM
Thank you for that infomation
SuperCoder Answered Wed 04th of July, 2018 00:28:29 AM

Thank you. Happy to help.

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