Gastroenterology Coding Alert

Question: What is the correct way to report EGD procedures making appropriate use of modifiers 52 and 53?

North Carolina Subscriber

Answer: Suppose you are reporting esophagogastroscopy codes from range 43235 to 43259, where the provider has not examined the duodenum, judging that it may not be clinically possible or required. There can be two case scenarios.

First scenario: The provider places a tube in stomach to perform EGD, and decides not to examine duodenum as it is not indicated. He also does not document any plans of a repeat examination later.  You may use the code 43237(Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) along with modifier 53 (Discontinued Procedure) if the provider plans for a repeat examination.

Second Scenario: The provider performs EGD in a blood filled stomach to find the cause of bleeding. The provider does not examine the duodenum as it is not possible. The provider decides to control the bleeding first, cleanse the gastric cavity by lavage, and then perform a repeat examination later. Here you may choose 43255 (Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method) with modifier 52 (Reduced Services) if the provider does not plan for a repeat examination.