Gastroenterology Coding Alert

Question: The doctor performs sclerotherapy for esophageal varices. How do we report this?

Utah Subscriber

Answer: In sclerotherapy the provider injects a sclerosing solution to treat the enlarged blood vessels in the esophagus. Your choice for an appropriate code will depend on the type of endoscope the provider used to view the esophagus in the first place. If the provider used a flexible endoscope, you may report 43204 (Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices), whereas if he used a rigid endoscope, you would use 43499 (Unlisted procedure, esophagus).

As per the AMA guidelines, for a given single site of lesion, you may not report 43204in conjunction with43201 (Esophagoscopy, flexible, transoral; with directed submucosal injection[s], any substance) or 43227 (Esophagoscopy, flexible, transoral; with control of bleeding, any method) for the same lesion. You will report a single most appropriate code. However, if the site of lesions are different you may use two codes as applicable, with modifier 59 (Distinct procedural service).

You might use 43243, (Esophagogastroduodenoscopy, flexible, transoral with injection sclerosis of esophageal and/or gastric varices) if the stomach and duodenum are also examined.