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?

Illinois Subscriber

Answer: You 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]). You can use this test to determine several gastrointestinal conditions -- esophageal cancer, gastric ulcer, and gastroesophageal reflux disease (GERD), to name a few.
 
Suggestion: On the op report for a diagnostic upper EGD, you would commonly see these five indicators:
 
1. Persistent upper abdominal distress despite trial of therapy
 
2. Dysphagia or odynophagia
 
3. Persistent or recurrent esophageal reflux symptoms despite a trial of therapy
 
4. Upper abdominal distress with symptoms suggesting a serious organic disease (anorexia, weight loss, etc.)
 
5. Persistent vomiting with no known cause.

Train your eye to look for these indicators on op reports, and you should be able to tell which claims are diagnostic upper EGDs.
 
If you-re unsure: Check with the gastroenterologist 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 gastroenterologist before sending the claim out.