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Gastroenterology Coding Alert

Keep Your EGD Coding in the 'Family'

Published on Sun Jul 10, 2005

Don't confuse biopsies with other procedure codes

For upper gastrointestinal endoscopy (EGD), you should know whether the procedure was diagnostic or surgical in order to select the appropriate code in the
EGD "family."

Family tree: The "parent" code in the EGD group is 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]), and the family concludes with 43259 (... with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate), says Stephanie Goodfellow, billing supervisor for Mid-America Gastrointestinal Consultants in Kansas City, Mo.

Key point: Coders use 43235 for diagnostic EGDs; every other code in the family represents an encounter in which a small surgical procedure, such as a biopsy, accompanies the EGD, Goodfellow says.

Rely On 43239 for Biopsies  

In the EGD family, the code that gets the most calls from gastroenterology offices is 43239 (... with biopsy, single or multiple), says Margie Pfaff, CPC, corporate compliance analyst for Wisconsin's Medical Associates Health Centers.

"An EGD is seldom done without a sign or symptom; thus, a biopsy is almost always taken. Diagnosis cannot be confirmed without pathology," Pfaff says.

Example: A patient with gas pain and nausea reports for an EGD. The gastroenterologist performs the EGD, taking a tissue sample for biopsy.

On the claim, you should:
 

  •  report 43239 for the EGD with biopsy.
     
  •  attach ICD-9 code 787.3 (Flatulence, eructation and gas pain) to 43239 to represent the patient's gas pain.
     
  •  attach ICD-9 code 787.02 (Nausea alone) to 43239 to represent the patient's nausea without vomiting.

    Know Other EGD Codes

    While many EGDs may include biopsies, there are also codes for EGDs performed in conjunction with other small surgical procedures.

    Let's say your gastroenterologist performs an EGD on a patient complaining of heartburn and difficulty swallowing. Then, during the course of the procedure, the gastroenterologist notices a foreign object in the patient's esophagus and removes it.

    On the claim, you should: 

  •  report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body) for the EGD and foreign-body removal.
     
  •  attach 787.1 (Heartburn) to 43247 to represent the patient's heartburn.
     
  •  attach 787.2 (Dysphagia) to 43247 to represent the patient's difficulty swallowing. 

    Symptoms for EGD Include GERD

    There are numerous symptoms a patient may display that prompt the gastroenterologist to perform an EGD, Pfaff says. These symptoms include: 

  •  gastroesophageal reflux disease (GERD)
     
  •  nausea and vomiting
     
  •  abdominal pain
     
  •  belching
     
  •  abnormal readings on radiological studies
     
  •  history of upper gastrointestinal problems (ulcers, gastrointestinal cancer, etc.)
     
  •  anemia of unknown entity
     
  •  Barrett's esophagus.

    Best bet: Check for these conditions in the operative notes before filing your EGD claim. Then, match the symptom up to the proper ICD-9 code on the claim.

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