Gastroenterology Coding Alert

Question: What methods can gastroenterologists use to treat esophageal and gastric varices, and how should I report these services?


Idaho Subscriber

Answer: Gastroenterologists typically treat esophageal and gastric varices (enlarged blood vessels) using one of two methods: endoscopic sclerotherapy and band ligation.

In the first step of endoscopic sclerotherapy, the gastroenterologist passes a needle attached to an endoscope through the esophagus and injects the varices with a sclerosing agent that causes the varices to clot and stop bleeding.

With band ligation, the physician uses an endoscope with a ligator attached to wrap bands around the varices and cease blood flow. If the varices are bleeding when the physician performs either treatment, you should report 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method).

But varices are not always bleeding when a physician administers treatment, in which case the gastroenterologist may perform a prophylactic sclerotherapy to prevent any future bleeding incidents.

You should use 43243 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with injection sclerosis of esophageal and/or gastric varices) to report the injection of sclerosis treatment into nonbleeding varices.

Your gastroenterologist may also perform a band ligation when the varices are not bleeding. In that case, you should use 43244 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices).