Gastroenterology Coding Alert

Question: I am having trouble recognizing diagnostic upper gastrointestinal endoscopies (EGDs), and have filed several claims incorrectly due to these lapses. What are some indicators in the operative notes that would lead me to code for a diagnostic upper EGD?

Montana Subscriber Answer: Coders should report the diagnostic upper EGD with 43235 (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 test can be used to determine several gastrointestinal conditions - esophageal cancer, gastric ulcer, and gastroesophageal reflux disease (GERD), to name a few.

Suggestion: On the operative reports for a diagnostic upper EGD, you would commonly see these indicators:
 Persistent upper abdominal distress despite trial of therapy
 Dysphagia or odynophagia
 Persistent or recurrent esophageal reflux symptoms despite a trial of therapy
 Upper abdominal distress with symptoms suggesting a serious organic disease (anorexia, weight loss, etc.)
 Persistent vomiting with no known cause. Train your eye to look for these indicators on operative reports, and you should be able to tell which claims are diagnostic upper EGDs.

If you're unsure: Check with the gastro who filled out the encounter form to make sure it is a diagnostic upper EGD. Take the time to get the final answer straight from the gastro before sending the claim out.