Gastroenterology Coding Alert

Question: Our gastroenterologist had difficulty passing the dilators during an upper GI endoscopy (EGD), so they used guide wires with endoscopic guidance. Do I still report 43233?

Indiana Subscriber

Answer: No, you would not report 43233 (Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)). The code you should submit needs to describe the guide wire and which one you choose will depend mostly on the extent to which the doctor advanced the scope.

You’ll likely report 43226 (Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire) if your gastroenterologist visualized only the esophagus, and perhaps proximal stomach. If the gastroenterologist advanced the scope beyond the pyloric channel, choose 43248 (Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire).