Rating Criteria | Rating Percentage |
---|---|
7206 – Gastroesophageal reflux disease | |
Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by=C2=A7 4.112(a)and treatment with either surgical correction of esophageal stricture(s) or percutaneous esophago-gastrointestinal tube (PEG tube) | 80 |
Documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement | 50 |
Documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year | 30 |
Documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic | 10 |
Documented history without daily symptoms or requirement for daily medications | 0 |
Note (1): Findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. | |
Note (2): Non-gastrointestinal complications of procedures should be rated under the appropriate system. | |
Note (3): This diagnostic code applies, but is not limited to, esophagitis, mechanical or chemical; Mallory Weiss syndrome (bleeding at junction of esophagus and stomach due to tears) due to caustic ingestion of alkali or acid; drug-induced or infectious esophagitis due to Candida, virus, or other organism; idiopathic eosinophilic, or lymphocytic esophagitis; esophagitis due to radiation therapy; esophagitis due to peptic stricture; and any esophageal condition that requires treatment with sclerotherapy. | |
Note (4): Recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved. | |
Note (5): Refractory esophageal stricture is defined as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals. |
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