Esophagogastroduodenoscopy (EGD) is an endoscopic test that permits direct visualization of the upper GI tract.
What is an Esophagogastroduodenoscopy (EGD)?
It is an endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum.
This test evaluates patients with dysphagia, weight loss, early satiety, upper abdominal pain, ulcer symptoms, or dyspepsia and is also used therapeutically for electrocoagulation, laser coagulation, or injection of sclerosing agents.
CPT codes for EGD range from 43235-43259 and are placed in the digestive section of the CPT manual to identify services performed during an esophagogastroduodenoscopy.
Consider the following coding guidelines when utilizing EGD CPT codes:
If any EGD service is not completely performed as mentioned in CPT, use modifier 52.
Never code ‘separate procedure” of the same family of EGD with any other code selection.
If there is bleeding because of an EGD, do not bill the bleeding control services.
Coding Tip -
Moderate sedation is no longer included in payment for gastrointestinal endoscopy services. If you provide moderate (conscious) sedation in conjunction with GI procedures you must now bill sedation separately with the appropriate moderate sedation CPT code(s) 99151, 99152, +99153, 99155, 99156, +99157, and HCPCS code G0500. This is important as the moderate sedation service was previously included in the relative value units (RVUs) for gastrointestinal endoscopy services. Failure to bill moderate sedation codes separately will result in a loss of revenue for these services.
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Coding Guidance
Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.
Documentation Requirements
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleID=57414
What is an Esophagogastroduodenoscopy (EGD)?
It is an endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum.
This test evaluates patients with dysphagia, weight loss, early satiety, upper abdominal pain, ulcer symptoms, or dyspepsia and is also used therapeutically for electrocoagulation, laser coagulation, or injection of sclerosing agents.
CPT codes for EGD range from 43235-43259 and are placed in the digestive section of the CPT manual to identify services performed during an esophagogastroduodenoscopy.
Consider the following coding guidelines when utilizing EGD CPT codes:
If any EGD service is not completely performed as mentioned in CPT, use modifier 52.
Never code ‘separate procedure” of the same family of EGD with any other code selection.
If there is bleeding because of an EGD, do not bill the bleeding control services.
Coding Tip -
Moderate sedation is no longer included in payment for gastrointestinal endoscopy services. If you provide moderate (conscious) sedation in conjunction with GI procedures you must now bill sedation separately with the appropriate moderate sedation CPT code(s) 99151, 99152, +99153, 99155, 99156, +99157, and HCPCS code G0500. This is important as the moderate sedation service was previously included in the relative value units (RVUs) for gastrointestinal endoscopy services. Failure to bill moderate sedation codes separately will result in a loss of revenue for these services.
Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Coding Guidance
Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.
Documentation Requirements
- All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
- Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service
). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
[*]The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleID=57414
