Gastroenterology Coding Alert

Question: How should we code for the gastroenterologist’s work treating esophageal and gastric varices?

Texas Subscriber

Answer: Gastroenterologists typically treat esophageal and gastric varices (enlarged blood vessels) using one of two methods: endoscopic sclerotherapy and band ligation. In the first step of endoscopic sclerotherapy, the gastroenterologist passes a needle through an endoscope into the esophagus and injects the varices with a sclerosing agent that causes the varices to clot and stop bleeding.

With band ligation, the physician uses an endoscope with a ligator attached to wrap bands around the varices and cease blood flow. If the varices are bleeding when either treatment could be performed, use 43255 (Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method) to report the procedures.

Varices are most often treated when not actively bleeding, even when sometimes the report may describe blood clots or old blood in the stomach. When treatment of non-bleeding varices is done, the doctor may perform a prophylactic sclerotherapy or prophylactic banding to prevent any future bleeding incidents.

Use 43243 (Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices) to report the injection of sclerosis treatment into non-bleeding varices. Note that sclerotherapy is now uncommonly done.

The gastroenterologist may also perform a band ligation when the varices are not bleeding. Use 43244 (Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices) for band ligation of non-bleeding varices. The code is reported once regardless of how many varices might be treated or how many bands applied.