Gastroenterology Coding Alert

Question: My physician plans to perform a repeat EGD on a patient with significant amount of food in his stomach. The initial EGD -- although completed -- is not satisfactory because of bad visualization of the stomach. What code(s) should I report?

Louisiana Subscriber

Answer: From your question, we will assume the first EGD was not fully completed because of the retained food. The GI postponed the repeat EGD for another day to allow the food to pass into the small intestine so the stomach is clear enough for visualization.

Upper endoscopy examinations have a global period of zero days (e.g., 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure], and 43244, ...with band ligation of esophageal/gastric varices). You should report the initial incomplete EGD with modifier 52 indicating a reduced service.

You should use the CPT® procedure code(s) that correspond to the service(s) performed on the follow-up EGD and the ICD-10 code(s) for the indications and findings.

EGD procedures on a subsequent day do not need any additional modifier as might be needed when a repeat examination takes place on the same calendar day (i.e., modifier 78, Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period).