The following information was taken the October 2008 CPT Assistant. Esophagoscopy – evaluation of the esophagus with the use of an endoscope that does not extend into the stomach. Esophagogastroduodenscopy (EGD) – evaluation of the esophagus, stomach, and either the duodenum or jejunum as appropriate. In some instances due to cancer or gastric procedures the patient may have an anastomosis present so the duodenum will be absent or bypassed and inspection of the jejunum takes place – this is what is meant by duodenum or jejunum “as appropriate.” Starting with some of our basic coding guidelines you would not report a diagnostic esophagoscopy (43200) or diagnostic EGD (43235) when a surgical procedure is performed because the diagnostic service is always included in the surgical procedure. If control of bleeding is necessary during a surgical procedure an additional CPT code is not reported because control of bleeding is a component of the overall service. Coding for esophagoscopy and EGD procedures contain the same elements such as biopsy, submucosal injections, treatment of varices, foreign body removal and removal of lesions by hot biopsy, bipolar cautery, snare or ablation techniques. “Cold biopsy” removal of polyp or lesion follows the same rational as a colonoscopy and would be reported with 43202 or 43239 “with biopsy.” There are a couple of things to remember about esophageal dilation;
1. If the endoscope is passed through a stricture to dilate it without the use of other equipment, the passage of the scope is a component of the esophagoscopy and an additional code is not reported for the dilation.
2. When performing an esophagoscopy a wire is passed through the scope into the stomach and dilation is then performed over the guidewire. Report CPT code 43226 even if the scope extended into the stomach since this would be considered incidental to the dilation procedure and a complete examination of the stomach did not take place.
3. If an endoscopy is performed and then the scope is removed and dilation occurs by an unguided bougie or sound such as a Hurst or Maloney dilator report both the endoscopy procedure and CPT code 43450 for the dilation.
CPT codes 43235-43259 series include visualization of the duodenum or jejunum so in instances where an EGD is performed and examination of the duodenum or jejunum does not take place it is appropriate to append your CPT code with modifier 52 for a reduced service.
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