Gastroenterology Coding Alert

Question: Can we bill both an EGD dilation and biopsy if done at the esophagus?


Kansas Subscriber


Answer: Yes, you can. First, you should determine what method the gastroenterologist used for the dilation. Was this a dilation with a balloon catheter (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]) or dilation with a guidewire (43248, - with insertion of guidewire followed by dilation of esophagus over guidewire)?

You should bill the procedure code with the higher relative value--the dilation code--as primary, and then 43239 (- with biopsy, single or multiple) as secondary and attach modifier 59 (Distinct procedural service) to show that the gastroenterologist performed the biopsy in a different anatomical location in the esophagus from the dilation.