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  1. Default 43234
    Medical Coding Books

    Please help. My physician did an upper GI endoscopy. The endoscope was introduced through the mouth and advanced to the gastric cardia. I'm not sure if 43234 is the correct code. I'm being told that the patient has to "swallow" the scope in order to use 43234. Does anyone have any advice on this?

  2. #2
    Below is the description for the cpt 43234...I don't see anywhere that the patient needs to 'swallow' the scope...

    The physician examines the upper gastrointestinal tract. The physician passes an endoscope through the patient's mouth into the esophagus. The esophagus, stomach, duodenum, and sometimes the jejunum are viewed. (This is for simple primary examination)

    On the other hand, if the doc is doing the procedure for diagnostic purposes I would go with the 43235 or 43239 if a biopsy was done.

    Hope this helps!

  3. #3
    For codes 43235 and 43239, does the endoscope need to be advanced to the duodenum and/or jejunum? If so, would a reduced services modifier be indicated for the OP's procedure?


  4. #4
    The intent is to reach the duodenum and sometimes the jejunum...for an incomplete procedure, then I would append modifier 52...If the doc only examines the esophagus, then I would consider coding 43200.

    Hope this helps, open to more feedback!!

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