UPPER GASTROINTESTINAL ENDOSCOPY CPT CODES

[Pages:3]MEDICAID CODING GUIDELINES

UPPER GASTROINTESTINAL ENDOSCOPY

CPT CODES:

43200

43202 43204 43215 43219 43220 43226

43227 43228

43234

43235

43239 43241 43243 43244 43245 43246 43247 43248

43249

43250

43251

43255 43258

Esophagoscopy, rigid or flexible; diagnostic, with

or without collection of specimen(s) by brushing or washing

with biopsy, single or multiple with injection sclerosis of esophageal varcies with removal of foreign body with insertion of plastic tube or stent with balloon dilation (less than 30mm diameter) with insertion of guide wire followed by dilation over guide

wire with control of bleeding, any method with ablation of tumor(s), polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Upper gastrointestinal endoscopy, simple primary examination (e.g., with small diameter flexible endoscope) 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 with biopsy, single or multiple with transendoscopic tube or catheter placement with injection sclerosis of esophageal and/or gastric varices with band ligation of esophageal and/or gastric varices with dilation of gastric outlet for obstruction, any method with directed placement of percutaneous gastrostomy tube with removal of foreign body with insertion of guide wire followed by dilation of

esophagus over guide wire with balloon dilation of esophagus (less than 30mm

diameter) with removal of tumor(s), polyp(s), or other lesion(s) by hot

biopsy forceps or bipolar cautery with removal of tumor(s), polyp(s), or other lesion(s) by

snare technique with control of bleeding, any method with ablation of tumor(s), polyp(s), or other lesion(s) not

amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

COVERED DIAGNOSIS:

008.5 112.84 146.0-146.9 150.0-150.9 151.0-151.9 152.0 197.4 198.89 211.0-211.2 230.0-230.2 230.7 235.2 235.5 261 262 263.9 280.0-280.9 300.11 306.4 307.1 438.82 456.0-456.21 456.8 530.0-530.9 531.00-531.91 532.00-532.91 533.00-533.91 534.00-534.91 535.00-535.61 536.0-536.9 537.0-537.9 553.3 555.0-555.9 556.0-556.1 557.0-557.9 562.00-562.03 564.2-564.4 571.2-571.5 572.3 578.0-578.9 579.0-579.9 747.20 750.3 783.0 783.21 783.22 783.3 786.50 786.59 787.01-787.03 787.1 787.2 789.01

Bacterial enteritis, unspecified Candidal esophagitis Malignant neoplasm of the oropharynx Malignant neoplasm of esophagus Malignant neoplasm of stomach Malignant neoplasm of duodenum Secondary malignant neoplasm of small intestine, including duodenum Secondary malignant neoplasm of other specified sites Benign neoplasm of esophagus, stomach, duodenum, jejunum and ileum Carcinoma in situ of esophagus and stomach Carcinoma in situ of other and unspecified parts of intestine Neoplasms of uncertain behavior, stomach, intestines, rectum Neoplasms of uncertain behavior, other and unspecified digestive organs Nutritional marasmus (for G tube placement) Other severe, protein-calorie malnutrition Other and unspecified protein-calorie malnutrition (for G tube placement) Iron deficiency anemias Hysteria, conversion disorder Physiological malfunction arising from mental factors, gastrointestinal Anorexia nervosa Late effects of cerebrovascular disease, dysphagia Esophageal varices Varices of other sites Diseases of the esophagus Gastric ulcer Duodenal ulcer Peptic ulcer, site unspecified Gastrojejunal ulcer Gastritis and duodenitis Disorders of function of stomach Other disorders of stomach and duodenum Diaphragmatic hernia Regional enteritis Ulcerative chronic enterocolitis and ileocolitis Vascular insufficiency of the intestine Diverticulitis of small intestine Postoperative digestive disorders Cirrhosis of liver Portal hypertension Gastrointestinal hemorrhage Intestional malabsorption Aorto-enteric fistula Tracheoesophageal fistula, esophageal atresia and stenosis Anorexia Loss of weight Underweight Feeding difficulties and mismanagement in the elderly Chest pain, unspecified Chest pain, other Nausea and vomiting Heartburn Dysphagia Abdominal pain, right upper quadrant

789.02 789.06 792.1 793.4 935.1 935.2 936 938 E864.0-E864.4 V10.03 V10.04

Abdominal pain, left upper quadrant Abdominal pain, epigastric Nonspecific abnormal findings in body substances, stool contents Abnormal x-ray GI tract Foreign body, esophagus Foreign body, stomach Foreign body, small intestine foreign body in digestive system, unspecified Caustic ingestion Personal history of malignant neoplasm, esophagus Personal history of malignant neoplasm, stomach

MC Part B News, 188 193

Revised:

SP 2/08/02

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