Gastroenterology Coding Alert

Question: What methods can gastroenterologists use to treat esophageal and gastric varices, and how should I  report these services?

Idaho Subscriber Answer: Gastroenterologists typically treat esophageal and gastric varices (enlarged blood vessels) using one of two methods: endoscopic sclerotherapy and band ligation.

In the first step of endoscopic sclerotherapy, the gastroenterologist passes a needle attached to an endoscope through the esophagus and injects the varices with a sclerosing agent that causes the varices to clot and stop bleeding.

With band ligation, the physician uses an endoscope with a ligator attached to wrap bands around the varices and cease blood flow. If the varices are bleeding when either treatment is performed, use 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method) to report the procedures.

Varices are not always bleeding when treatment is administered, however, in which case the doctor may perform a prophylactic sclerotherapy to prevent any future bleeding incidents.

Use 43243 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with injection sclerosis of esophageal and/or gastric varices) to report the injection of sclerosis treatment into nonbleeding varices.

The gastroenterologist may also perform a band ligation when the varices are not bleeding. Use 43244 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices) for band ligation of nonbleeding varices.