Gastroenterology Coding Alert

Question: How do you bill for the gastro banding procedure code 43244?

Illinois Subscriber

Answer: CPT 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) is just one of several codes you could use to report treatment of esophageal and/or gastric varices. Others include 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method), which you would use when the gastroenterologist treats bleeding varices with endoscopic sclerotherapy or band ligation, and 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), which you would use to report the injection of sclerosis treatment into non-bleeding varices.

If the gastroenterologist uses band ligation to treat bleeding varices, you will do best to code 43244. You would also apply 43244 for band ligation of nonbleeding varices. The supplies used during endoscopic procedures -- band ligators, injection needles, cautery probes, etc. -- are included in the facility claim from the hospital outpatient department or the ambulatory surgery center.

To have a better understanding of the difference between 43243, 43244, and 43255, check out the fee schedule for all three codes:

• 43243 reimburses about $273.17 (based on 8.04 RVUs for nonfacility multiplied by the 2011 conversion factor of 33.9764)
• 43244 compensates about $301.71 (based on 8.88 RVUs for nonfacility multiplied by the 2011 conversion factor of 33.9764)
• 43255 pays back about $288.46 (based on 8.49 RVUs for nonfacility multiplied by the 2011 conversion factor of 33.9764).