EGD CPT Codes

(2022) How To Code EGD – CPT Codes & Coding Guidelines

CPT codes for EGD range from CPT 43235 to CPT 43259. Underneath are the descriptions and coding guidelines for EGD with biopsy, EGD with balloon dilation, EGD with bravo, EGD with PEG tube placement, EGD diagnostic, EGD and colonoscopy, EGD with ablation, EGD with capsule placement, EGD with clip placement, anesthesia for EGD, EGD with botox injection and EGD endoflip.

The last section is about modifiers that can be used to report EGD.

EGD CPT Codes Guidelines

EGD coding and billing comparatively does not involve as much complex guidelines as coding and billing of other body system and specialties.

CPT codes for EGD ranges from the 43235 CPT Code until the 43259 CPT code have been placed in the gastrointestinal section.

Consider the following coding guidelines while billing EGD CPT Codes:

If any EGD service is not completely performed as mention in CPT, always use modifier 52.

Never Code “separate procedure” of same family of EGD with any other code of section.

If there is bleeding instance because of EGD procedure, do not bill the bleeding control services.

Many of CPT codes in EGD section have overlapping areas. If the services are becoming reasonable necessary and documents are supporting, use modifier 59, XE, XU, XS and modifier 51 depending on payer guidelines.

EGD With Biopsy CPT Code

The 43238 CPT code is used to bill an EGD with biopsy. Underneath the descriptions and the coding guidelines.

43238 CPT Code Description

Definition of CPT 43238: Esophagogastroduodenoscopy (EGD) flexible with trans-oral biopsy, single or multiple.

Coding Guidelines For CPT 43238

In order to report CPT 43238, the physician needs to examine the upper gastrointestinal tract for diagnostic purposes.

The physician uses an endoscope to pass through the patient’s mouth into the oesophagus.

To determine if tumors, bleeding, ulcers, erosions or other abnormalities are present the stomach, esophagus, duodenum and (sometimes) the jejunum are viewed.

Using biopsy forceps through the endoscope, single or multiple tissue samples from the upper gastrointestinal tract are obtained.

Modifier 52 and Modifier 53 are used to report the 43238 CPT code. Use the 52 modifier only when duodenum is not examined either deliberately or due to significant issues.

CPT Code EGD With Balloon Dilation

Balloon Dilation can be reported with the 43233 CPT code and the 43249 CPT code. Underneath are the descriptions and coding guidelines for the CPT codes for EGD with Balloon Dilation.

43249 CPT Code Description

Esophagogastroduodenoscopy (EGD) with flexible trans-endoscopic and trans-oral balloon dilation of esophagus.

Report CPT 43239 if the balloon dilation is less than 30 millimetres of diameter.

43243 CPT Code Description & Guidelines

Esophagogastroduodenoscopy (EGD) with flexible trans-endoscopic and trans-oral balloon dilation of esophagus.

Report CPT 43233 if the balloon dilation is more than 30 millimetres of diameter and includes fluoroscopic guidance.

Report the 43249 CPT code if the balloon is dilated less than 30mm and the 43233 CPT code if the balloon is dilated 30mm or more.

EGD With Bravo CPT Code

CPT 91035 can be used for bravo acid reflux. This CPT code needs to be reported with CPT 43235 and CPT 43239.

91035 CPT Code Description & Guidelines

Defintion of CPT 91035 is: Esophagus, GE reflux test; with mucosal attached telemetry pH electrode placement with recording, analysis and interpretation.

This test allows physicians to evaluate the frequency and duration of the acid reflux helping in understanding a patient’s condition.

The capsule device is attached to the esophageal tissue to detect the pH levels and transmits whole data to the recorder. A report is generated at the end that is then reviewed by the physician.

Use modifier 26 with the 91035 CPT code when the service is billed.

CPT Code For EGD With PEG Tube Placement

The 43246 CPT code can be used to bill EGD with PEG tube placement. Underneath the description and coding guidelines to bill this correctly.

43246 CPT Code Description & Guidelines

Definition of CPT 43246 is: Esophagogastroduodenoscopy (EGD), flexible, trans-oral; with directed placement of percutaneous gastrostomy tube.

In order to report the 43246 CPT code; the physician needs to use an endoscope to examine the upper gastrointestinal tract to guide placement of a gastrostomy tube.

The physician has to pass an endoscope through the patient’s mouth into the esophagus. The physician views the;

  • stomach;
  • duodenum;
  • esophagus;
  • and sometimes the jejunum.

For percutaneous placement of a gastrostomy tube, using fluoroscopy, see the 49440 CPT code.

Replacement of a gastrostomy tube without the use of imaging or endoscopy is reported with the 43762 CPT code or the 43763 CPT code.

Report the appropriate endoscopy CPT code for each anatomic site examined. Surgical endoscopy includes a diagnostic endoscopy; however, diagnostic endoscopy can be identified separately when performed at the same surgical session as an open procedure.

EGD Diagnostic CPT Code

The 43235 CPT code can be used to report EGD Diagnostic. Underneath the description and coding guidelines.

43235 CPT Code Description & Guidelines

Definition of CPT 43235 is: Esophagogastroduodenoscopy (EGD), flexible, trans-oral; diagnostic, including collection of specimen or specimens by brushing or washing, when performed as a separate procedure.

In the 43235 CPT procedure, the doctor examines the upper GI tract for diagnostic purposes. The physician passes an endoscope into the patient’s mouth through the esophagus.

In CPT 43235, specimens can be obtained by brushing or washing the esophageal lining by normal saline, followed with aspiration.

Report the 43236 CPT code instead of the 43235 CPT code if the physician is injecting any substance into the submucosa through the scope while viewing the upper GI tract.

The 43235 CPT code has 000 days global period. Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount.

Evaluation and management services on the day of the procedure generally not payable.

CPT Code For EGD And Colonoscopy

CPT for EGD ranges from the 43235 CPT code to the 43259 CPT code while codes from colonoscopy starts from the 45378 CPT code. Use endoscope trans-oral in EGD while in colonoscopy it is through rectal endoscope mostly.

Example: Let’s say a doctor has performed an EGD but there is some area left as endoscope that can not pass from duodenum to large intestine.

For that reason, the doctor chooses to perform the colonoscopy through the rectum to see the colon area. Both body areas are separate and there is no overlapping of services in this case.

Modifiers

No modifiers are requirerd as there is no CCI edit exist between these codes from both families. Some insurance require to use modifier 51 with the procedure having a low dollar amount.

The colonoscopy procedures follow the same guidelines as EGD. Use modifier 52 if the scope is not approached to the desired point.

CPT Code For EGD With Ablation

The 43270 CPT code can be used to report EGD with ablation. Underneath the description and coding guidelines.

43270 CPT Code Description

Definition of CPT 43270 is: Esophagogastroduodenoscopy, flexible, trans-oral; with ablation of a tumor or tumors, polyp or popyps or other lesion/lessions. Includes when performed;

  • post- dilation;
  • pre-dilation; and
  • guide wire passage.

The time duration for the 43270 CPT code is 1 hour and 31 minutes.

Modifier

Code modifier 52 when duodenum is not examined either deliberately or due to significant issues and a repeat procedure will not be performed.

Report modifier 52 and modifier 53 together when duodenum is not examined either deliberately or due to significant issues and a repeat procedure is planned.

EGD With Control Of Bleeding And Argon Plasma Coagulation

The 43255 CPT code can be used to report EGD with control of bleeding. Underneath the description and guidelines.

43255 CPT Code Description

Defintion of CPT 43255 is: Esophagogastroduodenoscopy (EGD), flexible, trans-oral; with control of bleeding, any method.

How To Bill The EGD With Control Of Bleeding CPT Code

In order to report the 43255 CPT code, the physician will use an endoscope to reach and control bleeding of the upper GI tract.

The doctor passes an endoscope into the patient’s mouth and through the esophagus. Normal control of bleeding can be achieved.

Biopsy or bleeding due to endoscope may not be billed with CPT 43255. Any problem arises during EGD procedure should be part of original services and therefore only the 93255 CPT code should be reported.

How To Bill The EGD With Argon Plasma Coagulation CPT Code

The 43255 CPT code can also be used for EGD with argon plasma coagulation. Report CPT 43258 when the lesion or area is not actively bleeding and the physician finds the lesion which is suspected of being a prior source of bleeding and uses a device to ablate the lesion.

The 43255 CPT code describes EGD with control of bleeding by any method. APC involves using AG gas and electrical current to seal irregular tissue without any direct contact.

This technique is always useful in treating conditions such as Barrett’s esophagus, esophageal cancer or rectal bleeding.

Report the appropriate endoscopy CPT code for each anatomic site examined.

CPT Codes For EGD With (Video) Capsule Placement

There are two CPT codes for placement/advancement of capsules depending on which part is being approached. Namely; CPT 91110 and CPT 91111.

CPT 91111 can be reported for esophagus and the 91110 CPT code for Esophagus through ileum. Underneath are the descriptions and coding guidelines.

91111 CPT Code Description

Definition of CPT 91111 is: Gastrointestinal tract imaging, intraluminal (for example: capsule endoscopy). Esophagus with report and interpretation.

91110 CPT Code Description

Definition of CPT 911110 is: Gastrointestinal tract imaging, intraluminal (for example: capsule endoscopy). Esophagus through ileum with report and interpretation.

Coding Guidelines For EGD With Capsule Placement

Report the 91110 CPT code when the imaging includes the esophagus through the ileum. Report the 91111 CPT code when the imaging is of the esophagus only.

CPT 91110 and CPT 91111 have both a technical and professional component. To report only the professional component, append modifier 26.

To report a technical component, append modifier TC. To report the complete procedure (the professional and technical components), submit the 91110 CPT code without a modifier.

Visualization of the colon is not reported separately. Report modifier 52 if the ileum is not visualized. Do not report CPT 91110 and CPT 91111 together or with CPT 0355T.

Measurement of gastrointestinal tract transit times or pressure via a wireless capsule is reported with the 91112 CPT code.

The ingestion of the capsule is always the part of the test and any Evaluation and Management service should not be billed for this purpose.

Note: Capsule endoscopy is covered for EGD but not for colonoscopy regions.

Coding Guidelines For EGD With Video Capsule Placement

The 91110 CPT code can be use for this procedure. This is a procedure for direct visual for the small bowel and is from the medicine section, therefore modifier 26 and modifier TC are applicable.

The date of service should be the date on which the report was interpreted by doctor or provider.

Modifier 52 should be reported if the ileum part is not visualised during the examination. When done in a facility (hospital inpatient or outpatient setting), both the facility and the provider will report a charge for their portion of the procedure provided.

EGD With Clip Placement CPT Code

An endoscopic clip is used to avoid the surgery closing to surfaces with an endoscopic. There is no CPT code for EGD with clip placement. Most payers have different guidelines and other ways to bill this service.

The best way to code and bill these services is to check the purpose of this service using code like bleeding control with the supply code from the HCPCS section.

The second approach to bill this service is by using an unlisted or unspecified code like the 44799 CPT code and using it with EGD diagnostic services.

CPT Codes For Anesthesia For EGD

There are five CPT codes for anesthesia services provided with EGD code section. Descriptions and coding guidelines for the 00731 CPT code, 00732 CPT code, 00811 CPT code, 00812 CPT code and the 00813 CPT code can be found underneath.

00813 CPT Code Description

Definition of CPT 00813: Anesthesia for combined lower and upper gastrointestinal endoscopic procedures. Endoscope introduced both distal and proximal to and distal to the duodenum.

00812 CPT Code Description

Definition of CPT 00812: Screening colonoscopy. Anesthesia for lower intestinal endoscopic procedures. Endoscope introduced distal to duodenum.

00811 CPT Code Description

Definition of CPT 00811: Endoscope introduced distal to duodenum. Anesthesia for lower intestinal endoscopic procedures. Not otherwise specified.

00732 CPT Code Description

Definition of CPT 00732: Endoscope introduced proximal to duodenum. Endoscopic retrograde cholangiopancreatography (ERCP). Anesthesia for upper gastrointestinal endoscopic procedures.

00731 CPT Code Description

Definition of CPT 00731: Endoscope introduced proximal to duodenum. Not otherwise specified. Anesthesia for upper gastrointestinal endoscopic procedures.

Coding Guidelines

Medicare and commercial insurance does the time units by 10 and 15 minutes per unit.

Sedation administrations do incorporate every one of the administrations that are related with the administration and monitoring of analgesia or anesthesia to a patient in order to produce partial and complete loss of sensation Instances of various techniques for sedation incorporate moderate sedation, checked sedation care (MAC), provincial sedation and general sedation.

Modifiers

Use modifiers that are associated with anesthesia services like modifier AA, modifier AQ, modifier QX or modifier QK. Patient condition is shown by “P” modifiers and the units of anesthesia is updated by the multiple of time units.

CPT Code For EGD With Botox Injection

The 43236 CPT code and the J0585 HCPCS code can be used to report EGD with a botox injection. Underneath are the descriptions of the CPT codes and the coding guidelines for this procedure.

43236 CPT Code Description

Definition of CPT 43236: Upper gastrointestinal endoscopy including;

  • stomach;
  • esophagus.

Either the duodenum or/and jejunum as appropriate. With directed submucosal injection or injections (any substance).

HCPCS Code J0585 Description

Definition of HCPCS J8585: Injection, Onabotulinumtoxina. 1 Unit (e.g. botox).

Coding Guidelines

The injection is reported by Medical by using the 43236 CPT code and Botox supply is billed with the HCPCS code J0585. The physician examines the upper gastrointestinal tract for diagnostic purposes.

The 43236 CPT code is reported when if the physician injects any substance into the submucosa through the scope while viewing the upper gastrointestinal tract.

EGD Endoflip CPT Code

The 91040 CPT code can be used to report EGD with Endoflip. Underneath is the description and coding guidelines for this procedure.

91040 CPT Code Description

The definition of CPT 91040 is: Esophageal balloon distension study, diagnostic, with provocation when performed.

What Is Endoflip?

The Endoflip impedance polarimetry system is for use in an office settings to measure pressure and dimensions during evaluation.

It has been advised to be used as an adjunct to other major diagnostic methods as part of a comprehensive evaluation of patients with symptoms consistent with gastrointestinal motility disorders.

Coding Guidelines

Use modifier 26 if you are billing only professional services and TC modifier for technical component. Report the 91040 CPT code globally without modifier if both components are used in the same setting.

EGD CPT Codes & Modifiers

The most common modifiers that are used are already discussed in above section; namely:

Only apply modifier 59 when CMS or CPT normally bundle the procedures, but you need to indicate that the physician performed those procedures at separate locations.

Modifier 51 can be used to report multiple surgeries with high and low dollar amount performed on the same day, during the same surgical session on same day by same provider.

It is used to identify the subsequent procedures to third party payers and it can be used to document two procedures in two different coding categories performed on the same day (e.g. EGD and colonoscopy).

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