When a simple dilatation (of a stricture) with sound or bougie is rendered in conjunction with an endoscopic procedure (e.g., esophagoscopy), both the endoscopic procedure and tariff 3092 will be paid at 100%.
As per the table below, where a balloon device (and not sound or bougie) is utilized to dilate the stricture, Tariff 3000 is payable as an add-on at 100% in addition to the fee for the endoscopic procedure.
The following “add-on” Tariffs are payable at 100% when claimed in addition to a gastrointestinal endoscopic procedure tariff.
|3000*||Balloon dilatation of colonic, pyloric, esophageal or small bowel strictures|
|3004*||Hemostasis G.I. Tract by endoscopic method or technique (e.g., cautery, injection, banding)|
Note: Claims for Tariff 3006 must indicate that the patient exhibits one (1) or more of the following: Pulse rate > 100/minutes; Blood pressure <80 systolic; hemoglobin < 80; Ongoing bleeding.
|3010||Insertion of small bowel or colonic stent(s) (includes dilatation if necessary).
Note: Tariff 3000 may not be claimed in addition to Tariff 3010.
|3196*||Ileal intubation, in conjunction with colonoscopy with or without biopsies|
|3012||Multiple, ten (10) or more, endoscopic biopsies|
|3013||Multiple, ten (10) or more, endoscopic biopsies of upper GI tract|
Updated: April 2018