Gastroenterology Coding Alert

Question: Our gastroenterologist performed a submucosal injection during endoscopy. Which code applies?

Florida Subscriber

Answer: CPT^® includes dedicated injection codes that apply when the physician inspects the submucosal area during upper or lower GI endoscopy and injects a therapeutic drug. The physician may also use a submucosal injection to mark a lesion (with a substance such as India ink) or lift a lesion for easier removal.

Upper GI: If your physician performs an upper endoscopy with injection, you have an option to report one of the following codes:

• 43192 Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance
• 43201 Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance
• 43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance

You should report 43236 for submucosal saline injections (as with endoscopic polypectomy which requires lifting the lesion before removing it by snare), botulinum toxin injection (for achalasia), India ink (for tattooing), steroid injection, or any other substance, excluding a sclerosant for esophageal/gastric varices or epinephrine to control bleeding. Look at the extent that the scope traveled to decide if the procedure was an esophagoscopy (43201) or an EGD (43236). Injections to help with polypectomy may contain other substances with saline like methylene blue or hyaluronic acid that help define the edges of the polyp to be removed.

Hint: Endoscopy that includes the duodenum or jejunum as part of the examination is an EGD.

Lower GI: If your physician performs a lower endoscopy with an injection, you’ll instead report one of the following codes, based on whether the physician performs a sigmoidoscopy or colonoscopy:

• 45335 Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance
• 45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance
• 44404 Colonoscopy through stoma; with directed submucosal injection(s), any substance

Caution: According to the CPT^® guidelines, you should not separately report these injection codes in conjunction with control of bleeding and endoscopic mucosal resection codes for the same lesion and location.