Gastroenterology Coding Alert

Question: How should I report an EGD with Argon plasma coagulation performed by our gastroenterologist for control of bleeding?

Answer: APC, short for Argon plasma coagulation, is a procedure for control of an actively bleeding lesion or it can be used to destroy a lesion suspected of being a bleeding site or abnormal tissue (ablation). When a physician performs it during EGD and finds an actively bleeding site, you would report 43255 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method). If the physician finds no active bleeding but finds a lesion suspected of being a prior source of bleeding, and uses APC to ablate the lesion, then you would report 43258 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique).

How it's done: APC involves using argon gas and electrical current to seal irregular tissue without any direct contact. This technique is useful in treating conditions such as Barrett's esophagus, esophageal cancer, rectal bleeding (post-radiation proctitis) and colonic polyps, among others.