note that 43245 is dilation of a gastric outlet; this appears to be an esophageal stricture and the only code defined for dilation of esophageal stricture in the egd family is 43248, dilation using a guide wire and 43249 dilation using a balloon. There are the dilation codes 43450-43456, but all define a device (e.g. Guide wire, balloon, etc.) used for dilation, not the scope. I would suggest 43235 is the appropriate code for this procedure.
you are right, 43245 is for gastric outlet and at the time i posted my response i did not have my book. With all due respect, the point is this....
43235 is a diagnostic egd, where nothing but visualization is done. Once an actual surgical procedure, such as biopsy or dilatation is performed, you can no longer bill the diagnostic code and you need to bill the appropriate surgical code and in this case it would be the appropriate dilatation code for the esophagus, dependent on the methodology of the dilatation.
This op notes states the dilatation was done thru the scope, this means it was guided. It was guided with a guide wire or a balloon that went thru the scope. The device is a key factor in determining whether or not you can bill additional procedures such as a biopsy at the same encounter. if this procedure were done as unguided, meaning scope was removed from patient and the esophagus was dilated without the use/visualization of the scope, then the scope was reinserted and advanced to the stomach where a biopsy was taken then you could bill both services.
I too, have many years of working for a GI doc and have attended many courses on how to bill these procedures correctly.
Lets not beat each other up over this, we are here to help but billing 43235 is an asc grouper 1 - whereas 43245 or 43248 is an asc grouper 2 with higher reimbursement.
you cannot bill 43235 at all once a surgical procedure has taken place because the surgical procedure includes the diagnostic study.