Gastroenterology Coding Alert

Question: If our gastroenterologist is treating a condition of gastric antral vascular ectasia, not bleeding, using the argon plasma coagulator, how do I code it?

Alaska Subscriber

Answer: Gastric Antral Vascular Ectasia (GAVE) is a condition that is often referred to as "watermelon stomach" due to the distinct watermelon-like appearance it provides to the stomach lining when it is observed using an endoscope. This is basically a type of arteriovenous malformation (AVM) that has a tendency to bleed. There were no proper diagnostic codes for GAVE until recently until 2006: (http://www.cdc.gov/nchs/data/icd9/agendasep06.pdf)

Under the new ICD-9-CM codes released, two codes were assigned to distinguish GAVE, depending on the presence or absence of hemorrhage.

• GAVE with hemorrhage 537.83 (Angiodysplasia of stomach and duodenum with hemorrhage)
• GAVE without hemorrhage 537.82 (Angiodysplasia of stomach and duodenum (without hemorrhage)

If your gastroenterologist is using any means of cautery, laser, heat probe or an argon coagulator to treat GAVE and to control bleeding (if any) you should report code 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method).