Coding for Upper GI Dilations Depends on Dilator Type and Method
Published on Mon Oct 01, 2001
Dilations are performed when a portion of the esophagus has become closed due to ailments such as reflux esophagitis -- associated scarring, following radiation therapy for cancer, from caustic ingestions or medications associated with ulcerations (such as Fosamax, Quinaglute) or a disease called achalasia. Patients with esophageal webs or rings that interfere with swallowing also frequently require dilation. Different types of dilators as well as some variations on their use can confuse coders. In addition, gastroenterologists may refer to the dilator they used by a brand name, and coders may be uncertain which CPT code is correct.
"Coders need to know what type of dilator was used and any other procedure the physician performed," says Roberta Classen, CPC, CPC-H, AAPC National Advisory Board member and financial manager of Charleston Gastroenterology Specialists in Charleston, S.C. "Sometimes the confusion comes from the physician's interpretation of what was done."
In performing dilation, the gastroenterologist must first evaluate the stricture and then decide what type of dilator to use, notes David Johnson, MD, a gastroenterologist with Digestive & Liver Disease Specialists in Norfolk, Va.
"The choice of dilator depends on the size and dynamics of the stricture and the physician's clinical judgment," Johnson says. "The patient's history also could play a part in the decision."
Dilations With or Without Endoscopy
Gastroenterologists use three basic types of dilators, Johnson explains, and each has its benefits based on the treatment approach dictated by the stricture's characteristics and cause. Some dilations are done with endoscopy, while others are not. Dilations without endoscopy are typically referred to and coded as manipulations. CPT 2001 includes a group of codes (43450-43458) in the surgery/digestive system section under the heading of manipulation. Codes for endoscopic dilations are in the endoscopy group of codes in the CPT manual.
Basic Bougie Provides Flexibility
Bougies are simple, flexible dilators that are available in increasing thicknesses. They may be passed down through the esophagus in succession to open the stricture gradually. Simple dilation with a bougie is often done in the gastroenterologist's office. The patient is placed in a sitting position, and an anesthetic spray is applied to the throat.
In describing this basic dilation procedure, the physician may use the names "Maloney" or "Hurst" to describe the dilator. These are both bougies, but they are distinguished by the shape of their tips, explains Peter Pardoll, MD, a gastroenterologist with the Center for Digestive Diseases in St. Petersburg, Fla., and co-founder of the National Gastroenterology Carrier Advisory Committee. The Maloney dilator's tip is pointed and the Hurst dilator's tip is more blunt.
"Use of the Maloney or Hurst dilators has gone by the wayside somewhat," he says. "More often you see dilations aided by endoscopy where we place a guide [...]
