General Surgery Coding Alert

Question: An endoscopic PEG tube placement procedure required some extra work, and I’m wondering how to code it. The surgeon performed the initial scope balloon dilation at the start of the procedure. But the esophageal tract narrowed, and the surgeon had to dilate it again, this time through blind bougie dilation. Can I code the second dilation separately?

Super coder Subscriber

Answer: No. Based on Correct Coding Initiative (CCI) edits the blind bougie dilation (43450, Dilation of esophagus, by unguided sound or bougie, single or multiple passes) is bundled as a column 2 code with the initial dilation code (43249, Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)). CCI lists the edit pair with a “0” modifier indicator, meaning that you can’t override the edit.

Don’t miss: You can separately bill the PEG tube placement, however, using 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube).

Because your surgeon performed two scope procedures, you can expect the multiple endoscopy payment reduction to apply to the fees you’ll receive for 43249 and 43246. This calculation takes out the base shared endoscopy fee (diagnostic esophagogastroduodenoscopy, in this case) from the second procedure. The payment reduction avoids duplicate payment for the shared portion of the procedure.