Cracking the Code

Coding Esophagogastroduodenoscopy

Esophagogastroduodenoscopy (EGD) is an endoscopic test that permits direct visualization of the upper GI tract. This test evaluates patients with dysphagia, weight loss, early satiety, upper abdominal pain, ulcer symptoms, or dyspepsia and is also used therapeutically for electrocoagulation, laser coagulation, or injection of sclerosing agents. CPT codes for EGD range from 43235-43259 and are placed in the digestive section of the Current Procedural Coding Expert book. Consider the following coding guidelines when utilizing EGD CPT codes: If any EGD service is not completely performed as mentioned in CPT, use modifier 52. Never code ‘separate procedure” of the same family of EGD with any other code selection. If there is bleeding because of an EGD, do not bill the bleeding control services. It is important that you check for any instructional notes for the CPT code that you are using for any instructions, includes or excludes notations.


Indications: 26-year-old male patient presents for an elective EGD. The patient believes he swallowed shards of glass; he is experiencing some epigastric pain.


Procedure: The gastroscope was passed with ease through the mouth under direct visualization; it was extended to the 2nd portion of the duodenum. The scope was withdrawn, and the mucosa was carefully examined. The views were good. The patient’s tolerance of the procedure was good. Retroflexion was performed in the cardia.


Findings: Hypopharynx: Normal, Esophagus: a short segment of salmon-colored mucosa with increased erythema and shallow erosion at the proximal end, biopsies obtained. Stomach: Normal Duodenum: Small polyp in D3, which was biopsied Complications: No evidence of glass shards or evidence of trauma from glass shards.

Q: What is the CPT code for this procedure?
A: CPT code: 43239 Rationale: During the esophagogastroduodenoscopy (EGD) the physician obtains biopsies of the esophagus and duodenum. We follow mapping to CPT code 43239 which includes the EGD and obtaining single or multiple biopsies.
Reference: FY 2022 Current Procedural Coding Expert, Merck Manual.
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