Gastroenterology Coding Alert

Question: Our gastroenterologist performed an upper gastrointestinal endoscopy with balloon dilation to 15 mm. He then placed a Wilson-Cooke 10-cm esophageal Z-stent. The diagnosis was esophageal stricture. What CPT codes should I use?

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Answer: CPT 2001 contains several new stent placement codes. Use 43256 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement [includes predilation]) to report the esophageal stent placement, according to Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT Advisory Panel.

Code 43256 is the only one you can bill in this situation. The stenting procedure includes the insertion of the scope, guidewire placement, tumor dilation (predilation with a balloon dilator) and stent deployment. All of these services are included in the fee for the stent placement, and cannot be billed separately. In your case, the balloon dilation to 15 mm is the same thing as predilation, which cannot be billed separately, Weinstein says.