General Surgery Coding Alert

Question: Our surgeon had performed a gastric bypass for a patient who returned five months later complaining of abdominal pain. The surgeon performed an EGD to assess the patient.

Please help me determine the proper code based on the following note:

Surgical "ring" from anastomotic pouch was reached endoscopically. Blind pouch measured approximately 10 cm. The efferent, true limb was traversed. Approximately 40cm

Wisconsin Subscriber

Answer: Your surgeon assessed the patient for his abdominal complaints by performing an upper esophagogastroduodenoscopy (EGD). CPT® provides several codes for the procedure based partially on how far into the GI tract the surgeon advances the scope. Based on your description, you should report 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for this case.

Because the surgeon is using the scope diagnostically, not to perform a procedure to correct a problem involving the prior gastric bypass, 43235 is the proper code choice.