Gastroenterology Coding Alert

Question: The documentation states that the gastroenterologist performed an EGD and placed three hemoclips to control bleeding. He also took a biopsy from the antrum portion of the stomach, as well as from the GE junction near the esophagus for H. pylori. How should I code this procedure? Would I use a modifier on one of them? As the biopsy was from different sites, can I use the biopsy code twice? This is multiple biopsies, but it is not multiple biopsies from the same site.

North Dakota Subscriber

Answer: You may report codes 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple) for the biopsy and 43255 (Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method) for control of bleeding. However, you have not mentioned whether the bleed was already present when the physician performed the EGD. You can only report both codes if the bleeding was not a result of the biopsy. If the surgeon caused the bleeding, you should only report 43239. If the surgeon did not cause the bleeding, both codes can be reported by adding modifier 59 (Distinct procedural service) to 43255 or the new modifier XS (Separate structure [A service that is distinct because it was performed on a separate organ/structure]).

For the biopsy(s), you should code 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple). The EGD codes are chosen by method and not sites. Moreover, a single esophagogastroduodenoscopy procedure encompasses all sites covered by the passing of the scope from the mouth, through the esophagus, through the stomach and pylorus (pyloric sphincter), and into the duodenum and/or jejunum. 

According to CCI edits, if a provider removes a polyp or takes multiple biopsies using a snare during an EGD, then the code assignment would be 43251 (Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor[s] polyp[s], or other lesion[s] by snare technique) no matter how many specimens were taken. The site in this case would not apply. 

Similarly, in your case, the code description for 43239 includes single or multiple biopsies. The same would apply if the provider biopsied several sites using biopsy forceps. Irrespective of the number of biopsies, the code would be 43239. A difference would come in if the provider used multiple methods on multiple sites. For instance, a gastric polyp removed using snare technique (43251) and esophageal biopsy (43239).