Gastroenterology Coding Alert

Question: Our gastroenterologist performed an upper GI endoscopy (EGD) on a patient with a Dieulafoy lesion. The procedure included removing an extensive amount of fresh blood and clots from the gastric body and fundus, which required a basket and snare to remove the clots. Are clots considered a foreign body? Can this be billed as 43247 along with 43255 for bleeding control?

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Answer: There is no code for removing blood clots during an EGD. However, “an object that is unintentionally placed (eg, trauma or ingestion) is considered a foreign body,” according to CPT^® guidelines. But blood clots are formed in the body, and therefore they’re not foreign to the body. To code this properly, you’ll only report 43255 (Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method), not 43247 (Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)). If there is sufficient documentation to support it, you may be able to append modifier 22 (Increased procedural services), but only if the notes clearly show that the gastroenterologist had to spend a very large amount of extra time and effort clearing the clots.