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Esophageal Dilation

Tammy Posted Fri 18th of November, 2011 15:35:11 PM

My physician done an EGD w/a biopsy and an InScope Optical Dilation of the esophagus. I know what code I need for the biopsy but what code do I use for the InScope Optical Dilation? I was thinking the 43245 but the descriptor states dilation of gastric outlet which would not be the correct anatomical site.

SuperCoder Answered Sun 20th of November, 2011 03:08:06 AM

If it is an UGI as in this case, then we have to select codes from the following three codes for dilation:

43245- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with dilation of gastric outlet for obstruction (eg, balloon, guide wire, bougie)

43249- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less than 30 mm diameter)

43248- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with insertion of guide wire followed by dilation of esophagus over guide wire

From the codes above, you are right that 43245 is incorrect.
From the codes 43249 and 43248, you have to check if it is a balloon dilation(43249) or a dilation of esophagus over a guidewire(43248).

Tammy Posted Mon 28th of November, 2011 20:30:33 PM

What if it was neither of the two? The physician stated that the placement of the dilator was directly placed without the use of a guidewire. The way that the physician explained it is that the scope is inserted then the strictire is found. The scope is removed then the optical dilator is directly placed. He suggested coding the dilation as 43450. Would this be appropriate?

SuperCoder Answered Mon 28th of November, 2011 21:03:24 PM

So, you wanted to say that Endoscope has been withdrawn first and then the dilator introduced without any guidance. In such a case, you can use the CPT code 43450 as the doctor has suggested. This is correct.
This info was not available in the first posting of question.

Tammy Posted Mon 28th of November, 2011 21:11:03 PM

I am sorry that I did not put this information in the original post but I did not have the information. Thank you very much for helping.

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