Gastroenterology Coding Alert

Question: I am new to gastroenterology coding. Can someone clarify for me what the wording for CPT® code 43235 means? It reads "... with or without collection of specimen(s) by brushing or washing (separate procedure)." My gastroenterologist is asking why he cannot bill for brushing as a "separate procedure" since that is what the descriptor states.

Virginia Subscriber

Answer: The descriptor to CPT® code 43235 reads "Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]". The code 43235 is used to report an upper gastrointestinalduodenoscopy (EGD) procedure that is purely diagnostic in nature. A descriptor that includes the phrase [separate procedure] means that this code may not be reported separately with a related procedure from any other codes in that family of services. In this case, it means that code 43235 is included in all of the other upper gastrointestinal endoscopy codes. The phrase "separate procedure" is not referring to the "collection of specimen[s] by brushing or washing".

If your gastroenterologist undertakes an EGD procedure for diagnosis with or without collection of specimens by brushing or washing, you can report this procedure with 43235. It does not matter whether or not your gastroenterologist collected specimens using a brush or by washing because the descriptor states, "with or without".

However, during the procedure, if your gastroenterologist detects some masses or polyps and decides to undertake a biopsy of the same with a biopsy forceps, then you cannot report the procedure with 43235. Here you report the procedure with 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple). And as explained above, you cannot report 43235 with 43239 as 43235 gets bundled with 43239 and cannot be reported separately.