Gastroenterology Coding Alert

Question: What is the proper code to report treatment of esophageal and/or gastric varices?


Colorado Subscriber


Answer: You have several code choices for treatment of esophageal and gastric varices (enlarged blood vessels), depending on the method the gastro-enterologist uses and the condition of the varices.

For bleeding varices, the GI physician may use endoscopic sclerotherapy, in which she passes a needle through an endoscope in the esophagus and injects the varices with a sclerosing agent that causes the varices to clot and stop bleeding.

A second method, called band ligation, involves using an endoscope with a ligator attached to wrap bands around the varices and cease blood flow.

If the varices were actively bleeding at the time of the procedure, you should report endoscopic sclerosis using 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method).

The physician may also treat varices that are not bleeding with endoscopic sclerosis. In other words, treatment is a prophylactic to prevent future bleeding. You should use 43243 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with injection sclerosis of esophageal and/or gastric varices) to report the injection of sclerosis treatment into nonbleeding varices.

If the gastroenterologist uses band ligation to treat bleeding varices, you will do best to use 43244 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices).

You would also apply 43244 for band ligation of nonbleeding varices.