Gastroenterology Coding Alert

Question: Our physician performed an endoscopic PEG placement that required some extra work. After initial dilation and the start of the procedure, the esophageal tract narrowed and had to be dilated again. No endoscope was used. Can I code the second dilation separately?

Connecticut Subscriber Answer: Yes, you can. Code the PEG placement 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). The patient required predilation of the esophagus in order to pass the scope, as well as a second dilation, so you should be able to code separately for the extra dilation work using 43450 (Dilation of esophagus, by unguided sound or bougie, single or multiple passes).
 
Multiple-procedure payment rules will apply even if you don't use the multiple-procedures modifier (-51).
 
- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, coding and billing coordinator for GI Diagnostic Endoscopy Center in Marietta, Ga.