Sunday 11 December 2016

CPT Code 43235 Esophagogastroduodenoscopy

43235 - Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 

NOTE: An ERCP is considered complete if one or more of the ductal system(s), (pancreatic/biliary) is/are visualized. To report ERCP attempted but with unsuccessful cannulation of any ductal system, see 43235-43259.

UPPER GASTROINTESTINAL ENDOSCOPY

CPT CODES:

43235 Upper gastrointestinal endoscopy including esophagus stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing

Esophagoscopy/EGD Crosswalk

Procedure : Brushing and washings 
Esophagus Only : 43200
EGD : 43235 

Endoscopic Biopsy

 43234 – Upper gastrointestinal endoscopy, simple primary examination (eg, with small diameter flexible endoscope) (separate procedure)

 43235 - Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

Ensure No More ICD-9- CPT® Code Confusions

You’ll agree – reporting the correct supporting diagnosis code along with the documented CPT® code is highly essential for any claims to be reimbursed. Here, you’d need to report ICD-9 codes 787.1 and 787.3 with CPT® code 43235. A small mismatch could mean losing out on your deserved $784.48 in reimbursement for procedures (EGD and Bravo insertion)! 
Esophagogastroduodenoscopy (EGD)

ICD9 code: 45.13 (without biopsy) and 45.16 (with biopsy) 

CPT codes: 43235, 43238, 43239, 43242, 44360, 44361, 44376, and 44377, 44385 and 44386

Gastroenterology

1. Gastroenterological procedures included in CPT code ranges 43753-43757 and 91000-91299 are frequently complementary to endoscopic procedures. Esophageal and gastric washings for cytology when performed are integral components of an esophagogastroduodenoscopy (e.g., CPT code 43235). 

Gastric or duodenal intubation with or without aspiration (e.g., CPT codes 43753, 43754, 43756) should not be separately reported when performed as part of an upper gastrointestinal endoscopic procedure. Gastric or duodenal stimulation testing (e.g., CPT codes 43755, 43757) may be facilitated by gastrointestinal endoscopy (e.g., procurement of gastric or duodenal specimens). 

When performed concurrent with an upper gastrointestinal endoscopy, CPT code 43755 or 43757 should be reported with modifier 52 indicating a reduced level of service was performed. 

2. The gastroesophageal reflux test described by CPT code 91035 requires attachment of a telemetry pH electrode to the esophageal mucosa. 

If a physician uses endoscopic guidance to attach the electrode, the physician should not report CPT code 43235 (esophagogastroduodenoscopy,...; diagnostic...) for the guidance procedure. The guidance is not separately reportable. 

Additionally it would be a misuse of CPT code 43235 since this code does not describe guidance, but a more extensive diagnostic endoscopy. 

Similarly the procedures described by CPT codes 91110 (gastrointestinal tract intraluminal imaging, esophagus through ileum) and 91112 (gastrointestinal transit and pressure measurement, stomach through colon) require a patient to swallow a capsule. 

If the patient cannot swallow a capsule, and a physician places it in the stomach using endoscopic guidance, CPT code 43235 should not be reported unless the physician performs a medically reasonable and necessary complete diagnostic upper gastrointestinal endoscopy procedure. CPT code 43235 should not be reported with modifier 52 for endoscopic guidance to place the capsule in the stomach.

GASTROESOPHAGEAL REFLUX DISEASE

43235 : Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Unbundling 

Unbundling occurs when multiple procedure codes are submitted for a group of procedures that are described by a single comprehensive code. 

An example of Unbundling would be fragmenting one service into component parts and coding each component as if it were a separate service. For example, the correct CPT comprehensive code to use for upper gastrointestinal endoscopy with biopsy of stomach is CPT code 43239. 

Separating the service into two component parts, using CPT code 43235 for upper gastrointestinal endoscopy and CPT code 43600 for biopsy of stomach is inappropriate (per CMS National Correct Coding Policy Manual). 

Upper endoscopy (esophagogastroduodenoscopy [EGD]) – 43235


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