EGD CPT Codes List For Esophagogastroduodenoscopy

EGD (esophagogastroduodenoscopy) is among the most commonly used tools by GI physicians (gastroenterologists) to find out what is happening in the upper part of the gastrointestinal system.

With a very simple upper endoscopy, a gastroenterologist inserts a small, thin, flexible endoscope into the patient’s mouth and visualizes the upper portion of the esophagus, stomach and the first portion of the duodenum. In the same session, the physician may also obtain biopsy samples, stop bleeding, remove polyps, or insert a feeding tube or stent.

That all said, capturing the correct CPT code for all of that work done during the upper endoscopy is essential. A single omission of any information could lead to a denied claim or loss of reimbursement dollars for the gastroenterologist. Coding errors are well-documented as one of the top causes of claim denials in outpatient settings, including procedures such as endoscopies.

In this guide, we will walk through the most important EGD CPT codes, what each one actually represents during an upper endoscopy, and how to tell them apart when you are staring at a procedure note at 4 p.m. on a Friday.

What are Esophagogastroduodenoscopy / EGD CPT Codes?

Esophagogastroduodenoscopy (EGD) CPT Codes are billing and coding identifiers assigned to an upper GI endoscopy by physicians to document the specific type of endoscopy they have performed. These procedure codes provide a common language for medical coders, billers, and insurance payors to identify what services were provided by a healthcare provider to the patient during an endoscopic examination.

CPT codes for EGD do more than simply indicate “endoscopy was performed.” Instead, there are multiple codes that represent various degrees of complexity and types of services rendered during the procedure. Examples include but are not limited to, codes 43235, 43239, 43245, 43247, 43246, 43249 and others for identifying the level of service provided.

For instance, some codes may indicate the physician performed only a diagnostic EGD to visually assess the patient’s esophagus, stomach, and duodenum. A different code would be used if the physician also obtained biopsies from areas of the upper gastrointestinal tract. Additionally, EGD CPT codes may also indicate additional services including dilations, control of active bleeding, removal of polyps, PEG tube placement, removal of a foreign object, or EUS guided procedures.

Therefore, although the EGD procedure takes place in the endoscopy suite, the story of the procedure is told on paper by selecting the correct CPT Code that best represents the service(s) provided.

Complete List of EGD CPT Codes and Their Descriptions

Below is a quick EGD CPT code cheat sheet that summarizes each esophagogastroduodenoscopy code, what it covers, and how it is used in day to day GI billing and coding:

You can click on any of these codes to read their complete description.

CPT Code	Description	EGD Type
43235	Basic look only upper endoscopy without biopsy or therapy.	Diagnostic EGD CPT code / standard upper endoscopy CPT code
43236	Upper endoscopy with medication or dye injected into the GI wall.	EGD with submucosal injection CPT code
43237	Endoscopic ultrasound exam focused on the esophagus and nearby structures.	EGD with EUS CPT code for the esophagus
43238	Endoscopic ultrasound used to study the stomach and surrounding tissue.	Upper EUS CPT code for gastric EUS during EGD
43239	Upper endoscopy with one or more biopsy samples taken.	EGD with biopsy CPT code / CPT code for esophagogastroduodenoscopy with biopsy
43244	Upper endoscopy with band ligation of esophageal varices.	EGD with variceal banding CPT code
43245	Upper endoscopy with balloon dilation of a stricture.	EGD with dilation CPT code / EGD with balloon dilation CPT code
43246	Upper endoscopy with placement of a PEG feeding tube.	EGD with PEG tube placement CPT code
43247	Upper endoscopy with removal of a foreign object from the upper GI.	EGD with foreign body removal CPT code
43248	Endoscopic dilation of a stricture performed over a guidewire.	EGD with guidewire dilation CPT code
43249	Complex balloon dilation of a tough or tight upper GI stricture.	EGD with complex balloon dilation CPT code
43250	Endoscopic removal of a polyp or lesion using a snare.	EGD with snare polypectomy CPT code
43251	Removal of a small lesion from the upper GI tract with forceps.	EGD with forceps lesion removal CPT code
43252	Destruction of abnormal tissue during EGD using energy such as APC or laser.	EGD with ablation CPT code
43253	Radiofrequency ablation of Barretts esophagus during an upper endoscopy.	EGD with radiofrequency ablation CPT code for Barretts esophagus
43270	Upper endoscopy using advanced or combined ablation techniques.	EGD with advanced ablation CPT code
43255	Upper endoscopy performed to find and stop active GI bleeding.	EGD with control of bleeding CPT code
43256	Endoscopic placement of an esophageal stent for bleeding or obstruction.	EGD with stent placement CPT code
43273	Injection of medicine during an EGD to treat bleeding or varices.	EGD CPT code for injection based bleeding management
43257	EUS guided endoscopic drainage of a pancreatic pseudocyst via stomach or duodenum.	EGD with EUS guided pancreatic pseudocyst drainage CPT code
43258	EUS guided placement of a stent into a duct, cyst, or fluid space.	EUS guided stent placement CPT code
43259	Complete diagnostic EUS exam of upper GI tract and adjacent organs.	Complete upper EUS CPT code
43260	Endoscopic stent placement to relieve gastric or proximal small bowel obstruction.	EGD with stent placement for obstruction CPT code
43274	More complex balloon dilation with multiple or repeated inflations.	Complex upper GI balloon dilation CPT code
43275	Endoscopic removal of an impacted food bolus from the esophagus.	EGD with impacted food removal CPT code

43235

CPT code 43235 is used when a physician performs a basic diagnostic upper endoscopy. This is the diagnostic EGD CPT code that is often used as the standard upper endoscopy CPT code.

In this exam, the physician looks at the esophagus, stomach, and sometimes the first part of the small intestine.

The purpose of this EGD code is to report a look only EGD. No tissue is removed and no active treatment is done. The physician may brush or wash the lining to collect samples, but no cutting or removal of growths is performed.

This EGD procedure code is reported when the endoscopy is done to check for visible issues such as inflammation, ulcers, or unusual areas that might need further testing or a more complex procedure later. It represents the simplest level of EGD in terms of both work and billing.

43236

43236 is used when a physician performs an upper endoscopy and also injects a substance into the wall of the digestive tract. This is the EGD with submucosal injection CPT code, and it is more than a basic look only EGD because it includes a therapeutic or marking step.

This variant of EGD code often comes into play when the physician needs to:

• Mark a spot for a future surgery
• Deliver medication to a specific area
• Inject a contrast agent to make tissue easier to see on imaging or during another procedure

In billing terms, 43236 is reported when the scope is done to inspect the upper GI tract and a submucosal injection is performed during the same session. For example, a physician may inject dye into the wall of the stomach so that a surgeon can easily find a lesion during a later operation.

43237

CPT code 43237 is used when a physician performs an upper endoscopy and adds ultrasound to study the esophagus. With this code, the focus is on using endoscopic ultrasound to see the wall of the esophagus and the nearby structures, not just the surface.

This is the EGD with EUS CPT code for the esophagus and is usually chosen when the physician needs a closer look at:

• The layers of the esophagus wall
• Nearby tissues and lymph nodes
• Possible tumors or thickening in the esophagus

From a billing point of view, 43237 tells the payer that this was more than a basic EGD. It was an EGD with ultrasound that focused on the esophagus and nearby areas to help with diagnosis and staging.

For example, a physician may report 43237 when a patient has trouble swallowing and endoscopic ultrasound is used to check for a hidden mass in the esophagus or swollen lymph nodes around it.

43238

CPT code 43238 is used when a physician performs an upper endoscopy and adds ultrasound to closely study the stomach and nearby structures. This is an upper EUS CPT code used for endoscopic ultrasound of the stomach during an EGD.

With this code, the scope is not just used to look at the surface. The built in ultrasound helps the physician see deeper layers of the stomach wall and the tissue around it.

This EGD procedure code is often reported when the physician needs more detail than a standard EGD can give. It helps assess stomach masses, areas of thickened tissue, or other suspicious findings that showed up on imaging or a prior exam.

For example, a physician may report 43238 when a patient has a stomach mass seen on a CT scan and endoscopic ultrasound is used to check how deep it goes into the stomach wall and to guide the next steps in treatment or staging.

43239

The 43239 procedure code is reported when a physician performs an upper endoscopy and takes one or more small tissue samples during the same session. This is the CPT code for esophagogastroduodenoscopy with biopsy that is used when a biopsy is done during an upper endoscopy.

The physician uses the flexible tube called a scope to visually examine the esophagus, stomach or duodenum. When the physician identifies an area of concern using the endoscope, he/she will use biopsy instruments to collect the abnormal tissue for examination.

This CPT code indicates that the physician did not only perform a look only at EGD, but also obtained a diagnostic biopsy to assist in understanding the patient’s symptoms. A biopsy is a method of obtaining tissue from a suspicious area. The physician then sends the collected tissue to the laboratory where it will be analyzed for conditions such as inflammation, infection or cancer. The results from the biopsy will enable the physician to determine the best course of action for treatment based upon these findings.

For example, a physician would report a 43239 CPT code when a patient presents with an unexplained source of bleeding, the physician performs an EGD and the physician collects a small biopsy from a suspicious area in the stomach to identify what is causing the bleeding.

43244

CPT 43244 is billed when a physician performs an esophagogastroduodenoscopy (EGD) and treats esophageal varices by banding the varices. This is the EGD with variceal banding CPT code, used when band ligation of esophageal varices is performed during an upper endoscopy.

When performing an EGD, a physician can locate the large veins in the lower portion of the esophagus using the scope and place small rubber bands around the veins to stop the flow of blood from these veins and decrease the risk of hemorrhage.

This diagnostic EGD CPT code would be coded if the purpose of the endoscopy is to treat the esophageal varices, not simply for diagnostic purposes. This coding could occur during an active hemorrhage. However, it could also occur during a scheduled procedure for patients who have a history of liver disease and portal hypertension.

With this code, the documentation of the treatment performed is essential. The physician must clearly indicate why they placed bands on the esophageal varices (i.e., to control an active bleed or as a preventative measure). Based upon this information, coders are able to determine which of the codes to use to support the claim for reimbursement by the healthcare payor.

43245

43245 is a type of EGD with dilation CPT code that is reported when a physician performs an EGD and also dilates a narrowed area in the upper GI tract during the same session. The gastroenterologist identifies a narrow section within the upper GI tract and uses a balloon, which is inserted through the endoscope to gently widen the narrowed section. This allows for normal movement of food throughout the digestive system.

Coding-wise, reporting CPT code 43245 informs the payer that the service provided was more than simply a diagnostic EGD. It involved therapeutic treatment of a stricture (narrowing), typically found in the stomach or duodenum, as part of a single combined procedure.

The documentation supporting the use of CPT code 43245 should include:

• Location of Stricture.
• Documentation that the Stricture was Dilated via the Endoscope.
• Method of Dilation (Balloon, Bougie, etc.).

Documentation will help the medical coding team determine whether 43245 is the most suitable choice of code for reporting the services rendered or if another EGD dilation code (like 43220) is more appropriate.

For example, a patient has long-standing Reflux Disease. The patient reports that food appears to be getting “stuck”. An endoscopy is performed. A narrowed area is identified and the physician performs dilation using a balloon during the same procedure. When the documentation supports this, 43245 is the most suitable choice to report both the scope and the dilation performed during the procedure.

43246

CPT procedure code 43246 represents the performance of an upper endoscopy along with placement of a PEG Tube on the same date of service. This is the EGD with PEG tube placement CPT code, used when a feeding tube is placed into the stomach with endoscopic guidance.

This type of procedure is commonly performed on individuals unable to consume food and liquids safely via their oral cavity, i.e., stroke victims, individuals with Parkinson’s disease, or advanced dementia patients. The intent is to provide long-term nutritional support and administration of medications.

When reporting for billing/coding purposes, 43246 indicates to the payer that:

• An EGD was performed,
• A Percutaneous Gastrostomy Tube was placed during that procedure,
• The stomach was accessed using endoscopic guidance.

In documentation, it should be clear to the reviewer that this was the first PEG tube placement and that endoscopy was used to place the tube in the stomach. If the tube was simply replaced/revised, a different CPT Code would most likely be appropriate (i.e., 43762 for percutaneous replacement of a gastrostomy tube without imaging/endoscopy, or 43763 for percutaneous replacement of a gastrostomy tube with imaging/endoscopy guidance).

43247

A doctor should use CPT code 43247 when he/she has taken an EGD and removed a foreign object from the upper GI tract of the patient in the same session. This is the EGD with foreign body removal CPT code and can be used when the foreign body is located in the esophagus, the stomach, or the duodenum.

To be able to bill 43247 for insurance reimbursement purposes, the important thing is that the physician did not simply use the scope to visually inspect the area of the foreign body, he/she actually had to use some instrument (like a snare, net, or forceps) that went through the endoscope to grasp the foreign object to remove it.

When looking at coding, 43247 tells the payor that the physician did actively remove the foreign object using the endoscope. It is most commonly used for foreign bodies that are objects such as coins, food boluses, small objects, or dental pieces that are stuck and cannot pass through the GI tract on their own.

Documentation should have details such as:

• the exact location where the foreign object was located
• if possible, the exact type of object (and how large)
• that removal was performed using an endoscope

This information will help demonstrate the need for 43247 and clearly separate it from a standard diagnostic EGD with no removal.

43248

43248 is a CPT code for esophagogastroduodenoscopy reported when a physician performs an upper endoscopy and the dilation of a stricture using a guidewire in the same session.

This is the EGD with guidewire dilation CPT code used when the stricture is dilated over a guidewire rather than with balloon only dilation. In this approach, the physician first passes the guidewire through the area of the stricture where it is narrowest. Then the physician will use the dilators to follow the wire so that they do not deviate from their intended track.

The guidewire assisted dilation CPT code 43248 would be billed if the physician dilated the stricture using a guidewire but did not use a balloon by itself to dilate. The guidewire assisted dilation may be necessary when the stricture is quite tight or is long enough that it requires a controlled method to widen the area.

To ensure clean coding and billing, the documentation should clearly indicate the following:

• An EGD was completed.
• A guidewire was placed across the stricture.
• Dilation was completed over the guidewire.

These details will allow the coder to determine whether the physician utilized the balloon only to dilate the stricture (and thus 43249 would be the correct CPT code), or whether the physician used a guidewire to assist the dilation (thus 43248 would be the correct CPT code).

43249

CPT code 43249 is used when a physician performs an EGD and carries out complex balloon dilation of a stricture during the same session. This is the EGD with complex balloon dilation CPT code, applied when the dilation involves more work than a simple, single balloon stretch.

This code usually applies when the physician:

• Performs multiple balloon stretches sequentially
• Use large-sized balloons to achieve a greater final diameter
• Repeatedly inflates the balloon to open a narrow, tough stricture

In terms of coding, 43249 signals to the payor that the physician performed a more complicated balloon dilation than the standard balloon dilation as indicated by 43245. This should be reflected in the physician’s note.

Some items the physician may look for in the report to support their claim for a more extensive balloon dilation include:

• Documentation using terms related to more complexity, i.e., “sequential” or “multiple balloon dilation”.
• The physician describes repeated balloon inflation(s) or increased balloon size to facilitate dilation.
• Specific location of the stricture and verification that the dilation was carried out via the endoscope.

43250

This type EGD CPT code is reported when a physician performs an EGD and removes a polyp, tumor, or other lesion using a snare during the same procedure. This is the EGD with snare polypectomy CPT code, and the goal of removing the lesion is for treatment, not for diagnostic purposes alone. The lesion is looped by the snare and typically removed as one piece.

This code does differ from a biopsy (e.g., CPT 43239), which only takes a tissue sample. When reporting CPT 43250, the goal is to report removal of the lesion as a therapeutic action.

To support clean coding and payment, the documentation must clearly indicate that:

• A snare was used to remove a lesion
• The lesion was located within the esophagus, stomach, or duodenum
• How many lesions were removed
• Whether complete removal of the lesion was attempted

When the provider’s documentation supports that a snare was used to remove the lesion, and not merely for sampling, then 43250 will be the correct procedure code to submit.

43251

A doctor may perform an esophagogastroduodenoscopy (EGD) and use a pair of forceps to remove a small lesion from the inside of the upper GI tract, all at one time. When this occurs, the doctor will report CPT code 43251. This EGD with forceps lesion removal CPT code is applied when the lesion is taken out using forceps during an upper endoscopy. Instead of looping the lesion with a snare, the physician grasps it with forceps and takes it out piece by piece or in a small chunk.

The key issue here is that this is a therapeutic procedure, not merely a sampling procedure. The doctor intends to remove the lesion from the patient, not simply examine it.

It is also important to look for wording in the medical records that can help guide the coder’s decision regarding which CPT code to assign. If the doctor states that a “sample” was obtained, this would support the assignment of a biopsy CPT code, most likely 43239 EGD CPT code.

On the other hand, if the doctor states that the “lesion was removed”, this supports the assignment of a therapeutic removal CPT code, most likely 43251.

In order to provide good documentation to assist the coder in choosing the correct CPT code, the doctor should indicate the type of instrument(s) used (e.g., forceps), the location of the lesion, and the nature of the procedure performed (removal vs. sampling). This additional information will allow the coder to select 43251 with a high degree of accuracy and prevent confusion between a removal-only service and a biopsy-only service.

43252

Procedure code 43252 is used for the destruction of abnormal tissue during an upper gastrointestinal (GI) EGD with an energy source. This is the EGD with ablation CPT code, applied when abnormal tissue is destroyed rather than cut out during an upper endoscopy. An example of this would be using an Argon Plasma Coagulator (APC), laser or thermal ablation to “burn” abnormal tissue at the time of the EGD instead of cutting it out.

43252 can be used for many different types of small abnormalities or precancerous changes located within the esophagus, stomach and/or duodenum. The main purpose for this code is to ablate the abnormality to reduce the risk of progression to cancer while preserving the remainder of the lining intact.

To support 43252 for coding and billing purposes, the note should contain the following information:

• That the patient underwent an EGD with ablation therapy
• The exact location of the abnormal tissue
• What energy modality was used to perform the ablation, i.e. APC, Laser, etc.

Providing specific details about the procedures that were performed supports the fact that the EGD was a therapeutic procedure, and not a routine diagnostic endoscopy, nor simply a biopsy.

43253

When a healthcare provider performs an upper GI endoscopy that includes using radio frequency ablation to treat Barrett’s esophagus, he or she reports CPT code 43253. This is the EGD with radiofrequency ablation CPT code for Barretts esophagus, that medical coders use when the abnormal Barretts lining is treated during the EGD. The purpose of this treatment is to eliminate the abnormal lining of the esophagus to reduce the likelihood of developing dysplasia or cancer, not just for looking or biopsy purposes.

43270

Advanced ablation techniques involve the combination of energy sources or the application of advanced energy delivery systems to treat tumors or lesions. This is the EGD with advanced ablation CPT code, used when the ablation performed during an EGD is more complex than standard ablation. This modality is generally considered to be more complex than standard ablation. Coders should seek documentation of “advanced” or “combined” techniques to assign this code.

43255

CPT code 43255 is reported when a physician uses an endoscope to find and treat active bleeding in the upper GI tract. This is the EGD with control of bleeding CPT code, where the physician’s primary goal is to perform the endoscopic gastroscopy to stop bleeding and not just to visually inspect the inside of the patient’s GI tract.

Physicians may use any of the following devices to control bleeding during the procedure; clips, cauterization, injection, or a combination of these methods to stop the bleeding. The specific device(s) used is less relevant to the reporting of this code, as long as the physician’s note indicates that there was active control of the bleeding performed during the scope examination.

Documentation required for clean coding of 43255 includes:

• Source of bleeding, e.g., ulcers or visible vessels,
• Area of treatment, i.e., esophagus, stomach, or duodenum,
• Methods of stopping the bleed, i.e., clips, cauterization, etc.

Coders should also keep one thing in mind. Small oozing after a polyp is removed is usually considered part of the removal service and is not billed separately as 43255. Only true control of bleeding as a separate, significant service supports this code.

43256

43256 also belongs to EGD coding family where it is utilized when an Endoscopic Gastroscopy with Esophageal Stent Placement is performed by a healthcare provider within the same procedure. This is the EGD with stent placement CPT code that a medical coding team applies when a stent is placed during an upper endoscopy to manage obstruction or bleeding. An Esophageal Stent can be placed to maintain the lumen open to facilitate passage of food, to control bleeding, or both.

In many cases, when a tumor or significant narrowing of the lumen exists, it may cause difficulty with passage of food, or result in continued bleeding. Therefore, this stent helps support the area from the inside and improves flow through the esophagus or another part of the upper GI tract.

To properly code this service, the medical records should state:

• That an EGD was performed
• That a stent was placed during the procedure
• Whether the main reason was obstruction, bleeding, or both

That detail helps support the use of 43256 and shows that this was a therapeutic endoscopy, not just a diagnostic scope.

43273

The 43273 CPT code tells that the physician has performed an EGD and has also treated active bleeding or varices by administering medication through the scope during the same procedure. The scope is not just for looking. The main goal here is to control or reduce bleeding.

During this service, the physician may inject:

• A vasoconstrictor (such as epinephrine) to decrease or stop bleeding
• Sclerosing agents (to create scarring of a varix or vessel)

It is helpful if the report contains the following statements:

• Injection therapy was performed during the EGD
• Location of the injection (e.g. ulcer, esophageal varix)
• Name or classification of the medicine(s) used for injection

Consider 43273 as the EGD CPT code for injection based bleeding management. If the note shows that the physician used the scope to inject medicine right at the problem spot, this is usually the code you are looking for.

43257

When a healthcare professional uses a real-time ultrasound to guide endoscopic drainage of a pancreatic pseudocyst via the stomach or duodenum, they would report the EGD CPT code 43257.

So this is the EGD with EUS guided pancreatic pseudocyst drainage CPT code, which focuses on the simultaneous use of an endoscope and ultrasound to locate and drain the fluid collection.

When reporting this code, the focus of coding will be the simultaneous use of both an endoscope and ultrasound to locate the fluid collection in the stomach or duodenum, and not the entire technical steps associated with draining the fluid collection.

This is generally reported by a gastroenterologist or advanced endoscopist. To properly report this EGD procedure code, the documentation in the patient’s medical record should specifically include three pieces of information:

• evidence of a pancreatic pseudocyst,
• an endoscopic approach was used,
• and ultrasound guidance was used during the drainage process.

If ultrasound guidance was not documented, then this EGD code should not be selected.

43258

This EUS assisted EGD CPT procedure code is used to document the stenting of a duct, cyst or fluid space under the guidance of Endoscopic Ultrasound (EUS). This code will demonstrate that a stent was placed using EUS to assist in that placement.

43258 can be applied if:

• Endoscopic Ultrasound (EUS) is present in the documentation, and
• Stent Placement was documented, and
• The documentation identifies a duct, cyst, or fluid space as the target.

43258 is most commonly used by gastroenterologists. Documentation for 43258 should include phrases similar to “EUS guided stent placement” or “EUS guided”. If the documentation only includes drainage without mentioning a stent, there are other EGD codes that would be more accurate (such as 43240 for transmural drainage of a pseudocyst with EUS guidance).

43259

43259 is the CPT code for a complete diagnostic EUS exam of the upper GI tract and adjacent organs. This is the complete upper EUS CPT code used when the entire upper GI tract and nearby structures are evaluated in a single exam. A complete diagnostic exam means that the esophagus, stomach, duodenum and any adjacent organs and lymph nodes were examined. Healthcare providers typically use this type of exam to stage cancer or to determine the extent of known masses.

Documentation supporting the application of 43259 should indicate that the exam was completed as a full review (survey), and not a quick, focused review of one specific area. The documentation may list each segment that was evaluated, or simply state that a complete EUS exam was performed.

If the documentation indicates only a focused or limited EUS exam was completed on a single lesion or region, then another EGD procedure code for ultrasound procedures would likely be a better choice than 43259. In essence, 43259 is part of the “complete tour” of the upper GI using EUS, and not the “quick peek”.

43260

This upper GI endoscopy CPT code applies when a provider places a stent to relieve an obstruction in the stomach or proximal small bowel. It is the EGD with stent placement for obstruction CPT code, showing that the scope was used not just for viewing, but to open up a blocked lumen so that food can pass again.

For 43260 to be a good fit, the report should clearly describe:

• The site of the obstruction
• That an endoscope was used to place a stent
• That the goal was to restore the passage of food or fluid

Also, payers will require additional information about the type of stent and its location, which is part of the code description. In addition, this code is designed to document a therapeutic stent placement, rather than simply doing a diagnostic procedure.

43274

43274 is used for more complicated balloon dilations of strictures in the upper GI tract compared to 43276, because there were multiple, sequential, or repeated inflations of the balloon. This is the complex upper GI balloon dilation CPT code from the EGD league, used when the provider performs repeated or sequential balloon inflations during the same endoscopic session.

Documentation that would support 43274 would include:

• Multiple balloons were used, or
• There were multiple inflations in the same session; for example “Sequential”, “repeated inflations”, etc.

If the physician’s documentation only includes a simple balloon dilation, the medical coder would likely want to choose a lower complexity EGD dilation code.

43275

This EGD with impacted food removal CPT code is reported when a provider removes an impacted food bolus from the esophagus with an endoscope. The focus of the code is on the removal of swallowed food that has become stuck, not on removal of a true foreign body.

The medical note should include:

• Impacted food in the esophagus
• Removal of the food with the endoscope, possibly using snares, nets, or retrieval devices
• Mention that the removed food item was not a non-food item (foreign body)

Medical coders should carefully distinguish between this code and foreign body removal codes. As food is typically swallowed, it is treated differently for billing purposes as a foreign body. This code is intended for “urgent” situations where food has become impacted in the esophagus and the physician used the endoscope to clear the impaction.

FAQs

1). Can a physician submit multiple EGD CPT codes for the same procedure?

Yes, but there are limits to doing so, and it depends upon the specifics of what the physician does.

Physicians can submit multiple CPT codes for the same EGD procedure if the physician conducts obviously independent services during the same session, e.g., a diagnostic procedure plus a PEG tube insertion. However, many procedures have their steps included within other CPT codes and therefore can’t be submitted independently.

Therefore, coders need to review payer-specific guidelines and official CPT guidelines to determine whether submission of another EGD code is acceptable, or if it would be considered a part of the bundle.

2). Do Esophagogastroduodenoscopy CPT codes need modifiers?

Yes, often. Modifiers are small additions to a CPT code to provide additional details about the service provided. Modifiers might be required for EGD codes when:

• Two separate distinct procedures were performed during the same visit.
• The complexity of the work exceeded normal expectations.
• There is a need to distinguish between the physicians’ professional services and the facilities’ services.

In general, EGD CPT codes identify the procedure completed by the physician, and the modifiers further refine the details of the service to make the claim more accurate and understandable for the payor.

3). How do EGD CPT codes relate to diagnosis codes like ICD 10?

CPT and ICD 10 are complementary systems of coding. The ICD 10 code identifies why the patient needed the procedure; i.e., bleeding, pain or difficulty swallowing.

The EGD CPT code describes what the physician did during the endoscopy.

When both parts of the claim accurately describe the patients’ records, the claim has greater potential for being processed without delay.

4). Are EGD CPT codes used differently in a hospital compared to an outpatient clinic?

While the actual CPT codes are identical, the way each is billed and reimbursed can vary by provider type.

Regardless of where the EGD takes place (i.e., a hospital, ambulatory surgical center (ASC) or office), the physician performing the EGD typically uses the same CPT code for the EGD. Where differences occur is:

• Who submits the professional charge (physician);
• Who submits the facility charge (hospital or ASC); and
• How the payer pays based upon the location of service.

Although the clinical service is essentially the same, the billing process and claim format may be very different depending upon the location where the service took place.

5). How do I determine if an EGD was diagnostic only or was also therapeutic?

Look at the operative report for guidance.

Diagnostic EGDs are primarily for visualization. The physician examines the upper GI tract, possibly takes images and collects biopsies.

Therapeutic EGDs treat problems. An example includes actively controlling bleeding; examples of others include removal of polyps, dilatation of strictures, placement of stents or ablation of pathologic tissue.

Documentation demonstrating only inspection and possible biopsy indicates the EGD is diagnostic-only and the appropriate EGD CPT code is most likely the diagnostic code. Documentation showing a problem was treated during the procedure demonstrates that a therapeutic EGD CPT code is the most likely choice.