Gastroenterology Coding Alert

Question: Our gastroenterologist performed balloon dilation to address an obstruction prior to placing a stent. Should I report 43220 with 43212?

New Jersey Subscriber

Answer: While a reasonable assumption, the answer is no. You should not report 43220 (Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)) with 43212 (Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)) in this situation.

Instead, report the procedure using 43212 alone. Although the code does not describe “balloon” dilation, it does specify that the procedure includes pre- and post-dilation, when performed. Additionally, notice that National Correct Coding Initiative (NCCI) edits bundle 43220 as a Column 2 code for 43212 with a modifier indicator of “0,” meaning that you cannot override the edit pair under any circumstances.