CPT code for Esophagogastroduodenoscopy (EGD) - 43235 - 43259

 What is an Esophagogastroduodenoscopy (EGD)?


It is an endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum.

CPT© codes in this series (43235- 43259) identify services performed during an esophagogastroduodenoscopy.



CPT Codes for Esophagogastroduodenoscopy


CPT Code Code Descriptor


43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed

43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance

43237 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures

43238 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine-needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) 

43239 Esophagogastroduodenoscopy, flexible, transoral; biopsy; single or multiple

43240 Esophagogastroduodenoscopy, with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed)

43241 Esophagogastroduodenoscopy, flexible, transoral; insertion of intraluminal tube or catheter

43242 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine-needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)

43243 Esophagogastroduodenoscopy, flexible, transoral; injection sclerosis of esophageal/gastric varices

43244 Esophagogastroduodenoscopy, flexible, transoral; band ligation of esophageal/gastric varices

43245 Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie)

43246 Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube

43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)

43248 Esophagogastroduodenoscopy, flexible, transoral; insertion of guide wire followed by passage of dilator(s) through esophagus over guide

43249 Esophagogastroduodenoscopy, flexible, transoral; transendoscopic balloon dilation of esophagus (<30 mm)

43233 Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

43250 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

43252 Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy

43253 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 

43254 Esophagogastroduodenoscopy, flexible, transoral; with EMR (endoscopic mucosal resection)

43255 Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method

43256 43256 has been deleted. To report, use 43266

43266 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and postdilation and guide wire passage, when performed)

43257 Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease

43258 43258 has been deleted. To report, use 43270

43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

43259 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis.


Esophagogastroduodenoscopy (EGD) – CPT© Codes 43235-43270


The American Society for Gastrointestinal Endoscopy (ASGE) works to ensure that adequate methods are in place for gastroenterology practices to report and obtain fair and reasonable reimbursement for procedures, tests and visits. To assist practices in understanding and implementing GI-specific coding, ASGE has developed coding sheets.The purpose of the coding sheet is to provide a high-level overview to support practices in there coding and reimbursement for 2018.


GUIDELINES

This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This guideline is solely for explaining correct procedure reporting and does not imply coverage and reimbursement.



DESCRIPTION


Upper gastrointestinal (GI) endoscopy, or esophagogastroduodenoscopy (EGD) is usually performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, and difficulty swallowing or bleeding from the upper GI tract. EGD is more accurate than x-ray films for detecting inflammation, ulcers, or tumors of the

esophagus, stomach and duodenum and can detect early cancer, as well as distinguish between benign and malignant conditions when biopsies of suspicious areas are obtained.


Esophagogastroduodenoscopy (EGD) uses a flexible fiber-optic scope with a light and camera to examine the upper part of the GI system. The scope is inserted through the mouth into the upper GI tract allowing for direct visualization of the esophagus, stomach, and duodenum through the camera. This document does not address

upper gastrointestinal (GI) endoscopy in children, wireless capsule endoscopy, virtual endoscopy or in vivo analysis of gastrointestinal lesions via endoscopy.



Gastroenterological procedures included in CPT code ranges 43753-43757 and 91010-91299 are frequently complementary to endoscopic procedures. Esophageal and gastric washings for cytology when performed are integral components of an esophagogastroduodenoscopy (e.g., CPT code 43235). Gastric or duodenal intubation with or without aspiration (e.g., CPT codes 43753, 43754, 43756) shall not be separately reported when performed as part of an upper gastrointestinal endoscopic procedure. Gastric or duodenal stimulation testing (e.g., CPT codes 43755, 43757) may be facilitated by gastrointestinal endoscopy (e.g., procurement of gastric or duodenal specimens).

When performed concurrent with an upper gastrointestinal endoscopy, CPT code 43755 or 43757 should be reported with modifier 52 indicating that a reduced level of service was performed.


GI Topics of Discussion


• Anatomy of the Upper Gastrointestinal Tract

• Esophagoscopy

• Esophageal Dilation

• Esophagogastroduodenoscopy

• EGD with procedures

• Anatomy of the Lower Gastrointestinal Tract

• Colonoscopy

• Colonoscopy with procedures

Upper Gastrointestinal Endoscopy

• Esophagogastroduodenoscopy

* Acronym = EGD

* Direct visual examination of the upper gastrointestinal tract by means of a flexible fiberoptic endoscope

* EGD describes a procedure in which the pyloric channel is traversed with the endoscope

* Code range 43235 - 43259



Deleted Codes


Three codes have been deleted in the esophagoscopy family.

Code 43219 – Stent or tube placement has been deleted; use new code 43212 to report Esophagoscopy, flexible, transoral; stent placement. The new code specifies the inclusion of pre- and post-dilation and guide wire passage when performed and includes moderate sedation as indicated by the moderate sedation symbol.

Code 43228 – Ablation of tumor has been deleted. A new code has been established for ablation of tumors with esophagoscopy (43229). The new code include pre- and post-dilation and guide wire passage when performed. Moderate sedation is included, as indicated by the moderate sedation symbol.

Code 43234, which described a simple primary upper endoscopy, has been deleted. To report a diagnostic esophagogastroduodenoscopy, 43235 should be reported, or one of the three diagnostic esophagoscopy codes as appropriate.


Guide Wire and Dilation


The EGD family includes a code for insertion of guide wire followed by dilation over guide wire. Insertion of guide wire code 43248 has been revised to describe passage of dilator(s) over a guide wire rather than dilation. Codes 43248 and 43249 (dilation codes) should not be reported with codes 43266 and 43270, as these codes (stent, ablation) include dilation.


Endoscopic Ultrasound (EUS)


Endoscopic ultrasound (EUS) examination codes 43237 and 43238 have been revised to describe EUS limited to the esophagus, stomach or duodenum and adjacent structures. Endoscopic ultrasound codes 43242 and 43259 have been revised to include examination of a surgically altered stomach where the jejunum is examined distal to the anastomosis. Clarification language has been included to address the extent of performance of the EUS examination as distinguished from the extent of the endoscopic visualization.


Pseudocyst Drainage


In addition to transmural drainage of pseudocyst as described in the current code 43240, EGD with transmural drainage of pseudocyst has been revised to specify that it includes endoscopic ultrasound, transmural drainage and placement of stent(s) to facilitate drainage, when performed.


Dilation Procedures

Dilation procedure codes have been added, revised and deleted to better describe current practice. EGD code 43249 has been revised to specify transendoscopic balloon dilation of less than 30 mm in diameter. Code 43233 (>30mm balloon, e.g., achalasia) includes fluoroscopic guidance, when used. Code 43245 has been revised

to describe dilation of gastric/duodenal stricture(s) and the guide wire example has been removed from the examples in parentheses. Code 43233 includes moderate sedation, as indicated by the moderate sedation symbol.


Control of Bleeding

The parentheticals for code 43255, EGD with control of bleeding code 43255 have been revised. Code 43255 should not be reported for treatment of esophageal/gastric varices, which are reported with more specific codes 43243 (sclerotherapy) or 43244 (banding). Code 43236, submucosal injection, would also not be reported if injection was part of the control of bleeding procedure.


New Codes

Balloon Dilation of Esophagus

EGD code 43233 (out of sequence) has been established to report balloon dilation of 30 mm in diameter or larger. This dilation procedure includes fluoroscopic guidance, when used. 



Endoscopic Mucosal Resection


Code 43254 has been established to report endoscopic mucosal resection (EMR) with EGD. Code 43254 includes removal of tumor(s), polyp(s) or other lesion(s) by snare technique (43251); directed submucosal injection(s) (43236); and band ligation (43254), so these services are not separately reportable when performed on the same

lesion during the same session. Biopsy (43239) performed on the same lesion as EMR is not separately reportable. Code 43254 includes moderate sedation, as indicated by the moderate sedation symbol.


Ultrasound-Guided Injections / Placement of Fiducial Markers


Code 43253 has been established to describe ultrasound-guided transmural injection of substances (e.g., celiac axis injection) or fiducial markers. This code includes endoscopic ultrasound (EUS) of the esophagus, stomach, and either the duodenum or a surgically-altered stomach where the jejunum is examined distal to the anastomosis.

Ablation of Tumors A new code has been established for EGD with ablation (43270). The new code includes pre- and post-dilation and guide wire passage when performed. Separate reporting of pre- or post-dilation or guide wire passage when performing ablation of the same lesion during the same session would not be appropriate. Ablation procedures are reported without a reduced services modifier 52, even if all three components (pre-dilation, post-dilation or guide wire passage) are not performed during the same session.


Placement of Stent

Revised code descriptor language for placement of an endoscopic stent in the esophagus states “pre-and postdilation and guide wire passage, when performed”. Code 43266, EGD with placement of stent is reported without a reduced services modifier 52, even if all three components (pre-dilation, post-dilation, and guide wire passage) are not performed during the same session. Separate reporting of pre-dilation, post-dilation or guide wire passage of the same lesion during the same session would not be appropriate.



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