Gastroenterology Coding Alert

Question: The physician took a quick look past the duodenum during an EGD. Do I instead code an upper GI enteroscopy?

Michigan Subscriber

Answer: No, it’s typically best to stick to the procedure outlined in the physician’s scope and intention. It’s not uncommon for a physician to take a quick look past the duodenum, but this kind of incidental look is usually just the physician trying to be thorough. If all the notes point to the physician’s intent to perform an esophagogastroduodenoscopy (EGD), then report that procedure with a code such as 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)), depending on the specifics of the procedure.

Reporting 44361 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple) when the documentation doesn’t show medical necessity will undoubtedly result in denial. Also, see the instruction preceding the enteroscopy codes which states “If an endoscope cannot be advanced at least 50 cm beyond the pylorus, see 43233, 43235-43259, 43266, 43270.” The wording “beyond second portion of duodenum” is not intended to mean that you’ll be going just a bit beyond, incidentally, just because you can.