Wiki 43239, 43248, 43453 (?)

[plynn]

help please....

Pre Indications: 1) GERD 2) Dysphagia

Findings: the tubular esophagus was normal. This was biopsied in the proximal and distal esophagus to rule out eosinophilic esophagitis as the cause of dysphagia. The esophagus was empirically dilated with a 54-French Savary dilator over a guide wire. Relook endoscopy did not show any tear in the esophagus. The stomach appeared to be normal. Biopsies were obtained in the antrum, incisura and the body to rule out H. pylori infection as the cause of abdominal pain. Biopsies were also obtained for CLOtest. The duodenal bulb look normal. The second part of the duodenal mucosa appeared to be flat. Biopsies were obtained to rule out celiac disease as the cause of abdominal pain. the patient tolerated the procedure well. No complications.

43248 is EGD with dilation of esophagus over guide wire - however does not include the biopsies

43239 is EGD with biopsies then 43453-51 would cover dilation of esophagus - however there was no mention of fluoroscopy (?)

Appreciate all the help I can get!!!

 

[Kisalyn]

You're looking at billing both 43248 and 43239 if the dilation was done endoscopically.

We had a couple of doctors long ago that would perform the endoscopy first and then use a maloney dilator. We billed the appropriate EGD CPT (EGD with bx, EGD snare, etc) and then 43450 with no modifiers.

 

[plynn]

Kisalyn

Thank you so much for taking the time to post a reply

Yes, if he does the dilation at the end without guide wire that is how I have been billing
(43239 & 43450)

With guide wire is where I was getting confused;
43239 & 43453 ....... but unsure since he was not documenting fluoroscopy for 43453
OR
43248 & 43239 ..... (?)

I really do appreciate this website which allows for feedback for multiple coders

 

[Kisalyn]

Well, the flow of statements make it sound like it was a dilatation with endoscopic assistance. If you know the provider and that he/she doesn't usually perform these, I'd query and make sure it's supposed to be 43453.

I still think 43248 and 43239.

Regarding the fluoroscopy, I don't see it mentioned in the CPT descriptor for 43453?