Gastroenterology Coding Alert

Question: My gastroenterologist performed an esophagogastroduodenoscopy (EGD) with three biopsies, then performed a fourth biopsy on a different site using ultrasound-guided aspiration. How should I code this?

Arkansas subscriber

Answer: It’s important that you are aware of what your gastroenterologist did while performing the EGD on the patient. With biopsies, for instance, keep in mind that no matter how many biopsies a physician takes during the endoscopy, you can only code one procedure: in this case, 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple). However, an exception allows you to bill 43238 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures)) if the physician also performed biopsies using ultrasound-guided aspiration on a separate anatomical site.

Note: Sometimes the physician might treat polyps or other lesions during an EGD. You have three CPT^® codes to choose from for lesion removals:

• 43250 (Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.
• 43251 (… with removal of tumor(s), polyp(s), or other lesion(s) by snare technique)
• 43270 (… with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)).

You can only code one EGD with lesion removal during the same session. However, if the physician treats different lesions with different procedures, you could append modifier 59 (Distinct procedural service) to the procedure of lesser value to override the edit. If you do that, make sure you are very clear in your documentation about the locations of the lesions and the method of removal or destruction.