Gastroenterology Coding Alert

Question: An EGD was performed. The esophageal lumen was noted to be totally obstructed in the distal esophagus with a large food bolus. The food bolus was disimpacted gradually with the help of biopsy forceps. How should I report this? Gastroenterology Discussion Group Answer: Although you state that an esophagogastroduodenoscopy (EGD) was performed, you do not indicate whether this procedure was conducted for a reason other than removal of a food bolus. If the physician performed the scope to remove the obstruction, which was in the esophagus, and did not examine the stomach and the duodenum, report an esophagoscopy. In contrast, if other indications warranted a complete examination, assign an EGD code. Regardless of procedure, choose the foreign-body component of either code. For the esophagoscopy with disimpaction, use 43215 (Esophagoscopy, rigid or flexible; with removal of foreign body). For the EGD with removal, report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body). Using the forceps does not constitute a biopsy. Coding Illustrated's description of the foreign-body removal codes states the foreign body "may be suctioned, or grasped with forceps and retracted through the scope" [emphasis added]. Using a biopsy code is incorrect. Biopsy codes are for removals of tumor(s), polyps(s), or other lesion(s), not foreign bodies. For the diagnosis, you should report 935.1 (Foreign body in esophagus). You Be the Coder and Reader Questions reviewed by Linda Parks, MA, CPC, lead coder at Atlanta Gastroenterology Associates; and Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel.