If the endoscope is removed prior to dilatation, as in over-the-wire dilatation, neither 43220 nor 43249 should be reported.
Instead, the balloon dilation should be reported "separately (eg, 43456 or 43458)," as appropriate, AND a diagnostic endoscopy code (43200 or 43235) would be used for the endoscopic guide wire placement.
The coding would be:
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