Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed an esophagoscopy and found varices. He proceeded to treat the varices using band ligation. How should I code this procedure? Are there any other codes to report treatment of varices? Is there a difference in reporting bleeding and nonbleeding varices? 

Iowa Subscriber

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

As your physician treated the esophageal non-bleeding varices using band ligation, you should report code 43205 (Esophagoscopy, flexible, transoral; with band ligation of esophageal varices). With band ligation, the physician uses an endoscope with a ligator attached to wrap bands around the varices and cease blood flow.

In endoscopic sclerotherapy, the gastroenterologist passes a needle through the endoscope into the esophagus and injects the non-bleeding varices with a sclerosing agent that causes the varices to clot and stop bleeding. For this procedure, you should report code 43204 (Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices). 

Varices are not always bleeding when treatment is administered, however, in which case the doctor may perform a prophylactic sclerotherapy to prevent any future bleeding incidents.

If the varices are bleeding when either band ligation or sclerotherapy treatment is performed, you should use 43227 (Esophagoscopy, flexible, transoral; with control of bleeding, any method) to report the procedure. However, if the physician caused the bleeding while performing the procedure and then proceeded to stop it, you can’t report the control of bleeding and will only report the primary procedure. 

Do not report 43204 or 43205 in conjunction with 43227 for the same lesion. If the procedure included examinations of the stomach and duodenum then the corresponding upper endoscopy (EGD) codes are 43243 ( Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices) and 43244 ( Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices).