Wiki Is this considered incomplete? EGD to duodenal bulb

I would consider this a complete EGD. The duodenal bulb is considered the proximal most portion of the duodenum closest to the stomach. Below are some resources explaining when an EGD is considered complete vs incomplete. Hope this helps!

CPT Assistant, Octoboer 2008 Pages 6,7 Category: Coding Clarification

Once an endoscope traverses the pyloric channel and enters the small intestine, the procedure is then described as esophagogastroduodenoscopy, or EGD. The first code in the EGD series is code 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 codes in the 43235-43259 series, the proximal duodenum or jejunum, as appropriate, is examined.

Q:
Is it appropriate to append modifier 52, Reduced services, to code 43235 if neither the proximal duodenum nor the jejunum is examined?

A: Yes. Code 43235 is intended to describe a complete esophagogastroduodenoscopy, which includes examination of the duodenum and/or jejunum. In the clinical scenario in which the proximal duodenum is not examined, it would be appropriate to append modifier 52 to code 43235. Portions of the jejunum, but not the duodenum, are inspected in situations where gastroenterostomy procedures have been performed (eg, Billroth II with antral removal; bariatric gastric bypass procedures). Code 43235 would still be reported for the diagnostic exam.

AMA CPT Book Nosology Help Message

When an EGD is performed and the duodenum is either deliberately not examined (deemed not pertinent), or there is a significant situation precluding a safe examination (e.g., significant gastric retention), report appropriate EGD code with modifier -52 if a repeat examination is not anticipated, or modifier -53 if repeat examination is planned.
 
I would consider this a complete EGD. The duodenal bulb is considered the proximal most portion of the duodenum closest to the stomach. Below are some resources explaining when an EGD is considered complete vs incomplete. Hope this helps!

CPT Assistant, Octoboer 2008 Pages 6,7 Category: Coding Clarification

Once an endoscope traverses the pyloric channel and enters the small intestine, the procedure is then described as esophagogastroduodenoscopy, or EGD. The first code in the EGD series is code 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 codes in the 43235-43259 series, the proximal duodenum or jejunum, as appropriate, is examined.

Q:
Is it appropriate to append modifier 52, Reduced services, to code 43235 if neither the proximal duodenum nor the jejunum is examined?

A: Yes. Code 43235 is intended to describe a complete esophagogastroduodenoscopy, which includes examination of the duodenum and/or jejunum. In the clinical scenario in which the proximal duodenum is not examined, it would be appropriate to append modifier 52 to code 43235. Portions of the jejunum, but not the duodenum, are inspected in situations where gastroenterostomy procedures have been performed (eg, Billroth II with antral removal; bariatric gastric bypass procedures). Code 43235 would still be reported for the diagnostic exam.

AMA CPT Book Nosology Help Message

When an EGD is performed and the duodenum is either deliberately not examined (deemed not pertinent), or there is a significant situation precluding a safe examination (e.g., significant gastric retention), report appropriate EGD code with modifier -52 if a repeat examination is not anticipated, or modifier -53 if repeat examination is planned.
Thank you so much for your reply!
 
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