The American Society for Gastrointestinal Endoscopy (ASGE) ensures that gastroenterology practices have effective methods for accurate reporting and fair reimbursement for procedures, tests, and visits.
To help healthcare providers handle GI-specific coding, ASGE has created coding cheat sheets. These sheets offer a concise overview, supporting practices in accurate coding and reimbursement for 2025.
What is Esophagogastroduodenoscopy (EGD)?
Esophagogastroduodenoscopy (EGD) is an endoscopic procedure used to examine the upper gastrointestinal tract, including the esophagus, stomach, and duodenum. CPT codes for EGD (43235-43259) describe the services performed during this procedure.
CPT Codes for Esophagogastroduodenoscopy
| CPT Code | Description |
| 43235 | Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed |
| 43236 | Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance |
| 43237 | Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach, or duodenum, and adjacent structures |
| 43238 | Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine-needle aspiration/biopsy(s), including endoscopic ultrasound examination limited to the esophagus, stomach, or duodenum, and adjacent structures |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; biopsy, single or multiple |
| 43240 | Esophagogastroduodenoscopy, with transmural drainage of pseudocyst (includes placement of transmural drainage catheter(s)/stent(s), when performed, and endoscopic ultrasound, when performed) |
| 43241 | Esophagogastroduodenoscopy, flexible, transoral; insertion of intraluminal tube or catheter |
| 43242 | Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine-needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) |
| 43243 | Esophagogastroduodenoscopy, flexible, transoral; injection sclerosis of esophageal/gastric varices |
| 43244 | Esophagogastroduodenoscopy, flexible, transoral; band ligation of esophageal/gastric varices |
| 43245 | Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (e.g., balloon, bougie) |
| 43246 | Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube |
| 43247 | Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s) |
| 43248 | Esophagogastroduodenoscopy, flexible, transoral; insertion of guide wire followed by passage of dilator(s) through esophagus over guide |
| 43249 | Esophagogastroduodenoscopy, flexible, transoral; transendoscopic balloon dilation of esophagus (<30 mm) |
| 43233 | Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) |
| 43250 | Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps |
| 43251 | Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
| 43252 | Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy |
| 43253 | Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (e.g., anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) |
| 43254 | Esophagogastroduodenoscopy, flexible, transoral; with EMR (endoscopic mucosal resection) |
| 43255 | Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method |
| 43256 | Deleted. Use 43266 |
| 43266 | Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) |
| 43257 | Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease |
| 43258 | Deleted. Use 43270 |
| 43270 | Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) |
| 43259 | Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis |
Modifier 52: Reduced Services
This modifier is used when a service or procedure is partially reduced or eliminated at the physician’s discretion. It’s appropriate when the provider plans or expects a reduction in the service, or electively cancels the procedure prior to completion. For example, if a colonoscopy is not completed as intended but is not discontinued due to patient risk, Modifier 52 would be appropriate.
Scenario:
A gastroenterologist starts a colonoscopy to examine the entire colon. However, due to poor bowel preparation, visibility is limited, and the scope is only advanced to the sigmoid colon. The physician decides not to continue further.
- How to Use: Append Modifier 52 to the colonoscopy CPT code because the service was partially completed by choice, not due to patient risk or complications.
- Example: Code as 45378-52 (Diagnostic colonoscopy, reduced due to incomplete examination).
Modifier 53: Discontinued Procedure
This modifier indicates that a surgical or diagnostic procedure was started but discontinued due to extenuating circumstances or those that threaten the patient’s well-being. It’s applicable when a procedure is terminated due to unforeseen complications that pose a risk to the patient after anesthesia has been administered. For instance, if a patient experiences a severe drop in blood pressure during a colonoscopy, leading the physician to halt the procedure, Modifier 53 should be used.
Scenario:
During a colonoscopy, the patient experiences a significant drop in blood pressure after anesthesia is administered. The physician halts the procedure to ensure the patient’s safety.
- How to Use: Attach Modifier 53 since the procedure was stopped due to a medical emergency that risked the patient’s well-being.
- Example: Code as 45378-53 (Diagnostic colonoscopy, discontinued due to patient condition).
Modifier XS: Separate Structure
This modifier denotes a service that is distinct because it was performed on a separate organ or structure. It’s used to indicate that a procedure was carried out on a different anatomical area than another procedure performed on the same day.
Scenario:
A patient undergoes an upper gastrointestinal endoscopy (EGD) for stomach pain and a separate colonoscopy for rectal bleeding on the same day. These procedures target different anatomical structures.
- How to Use: Use Modifier XS to indicate that the procedures are distinct because they were performed on separate body areas.
- Example:
- 43235 (EGD)
- 45378-XS (Colonoscopy on a separate structure)
Modifier XU: Unusual Non-Overlapping Service
This modifier is used when a service is distinct because it does not overlap usual components of the main service. It indicates that the procedure performed is separate and not typically included in another service provided on the same day.
Scenario:
A physician performs a colonoscopy and removes a polyp. During the same session, an unrelated biopsy is taken from a different site for a different medical reason.
- How to Use: Use Modifier XU to indicate the biopsy is a distinct and unusual service that doesn’t overlap with the polypectomy.
- Example:
- 45385 (Colonoscopy with polypectomy)
- 45380-XU (Colonoscopy with biopsy at a different site)
Modifier 73: Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia
This modifier applies when a procedure is terminated after the patient has been prepared for surgery but before anesthesia has been administered. It’s used by facilities to report discontinued procedures due to extenuating circumstances that do not involve patient risk.
Scenario:
A patient scheduled for an outpatient endoscopy develops severe anxiety and refuses the procedure after being prepped but before anesthesia is administered.
- How to Use: Append Modifier 73 because the procedure was discontinued before anesthesia due to extenuating circumstances.
- Example: 43235-73 (EGD, discontinued before anesthesia)
Modifier 74: Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia
This modifier is used when a procedure is terminated after anesthesia has been administered. It’s applicable when a procedure is discontinued due to unforeseen circumstances after the patient is under anesthesia, and it’s reported by the facility.
Scenario:
During a colonoscopy under anesthesia, the physician encounters a large mass obstructing the colon, making it unsafe to continue. The procedure is stopped.
- How to Use: Attach Modifier 74 because anesthesia was administered, and the procedure was terminated due to unforeseen complications.
- Example: 45378-74 (Colonoscopy, discontinued after anesthesia)
Preventive Services Modifiers:
Two specific modifiers used in the preventive services are:
- Modifier 33: Used for preventive services. When a screening procedure is converted to a diagnostic or therapeutic procedure for commercial insurance carriers, Modifier 33 should be appended to the CPT code.
- Modifier PT: Used for Medicare patients. When a screening colonoscopy is converted to a diagnostic or therapeutic procedure, Modifier PT is appended to indicate that the service began as a preventive service but changed based on findings during the procedure.
Scenario:
A Medicare patient undergoes a screening colonoscopy. A polyp is found and removed during the same session.
- How to Use: Append Modifier PT to signify that the procedure began as a screening but turned diagnostic/therapeutic.
- Example: 45385-PT (Colonoscopy with polypectomy, initially preventive for Medicare)
The Bottom Line
It’s essential to use these codes and modifiers accurately to reflect the specific circumstances of each procedure. Always refer to the most recent coding guidelines and payer policies, as definitions and applications can evolve over time.
References:
- https://www.asge.org/docs/default-source/coding/egd_2018-coding-sheet.pdf?sfvrsn=52ca050_4
- https://www.aapc.com/codes/cpt-codes-range/43235-43259/
- https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf
Frequently Asked Questions
What is the endoscopy CPT code for a diagnostic procedure?
The endoscopy CPT code for a diagnostic upper gastrointestinal endoscopy, also known as an esophagogastroduodenoscopy (EGD), is 43235. This involves examining the esophagus, stomach, and duodenum.
What is CPT 43239 used for in endoscopy?
CPT 43239 is used for an endoscopy procedure where a biopsy is taken using forceps during an esophagogastroduodenoscopy. It covers both the visual inspection and the tissue sampling.
What is the CPT code for EGD with PEG tube placement?
The CPT code for EGD with PEG tube placement is 43246. This procedure involves placing a percutaneous endoscopic gastrostomy (PEG) tube directly into the stomach for feeding, guided by endoscopy.
What is an esophagogastroduodenoscopy?
An esophagogastroduodenoscopy is an endoscopic procedure that examines the lining of the esophagus, stomach, and duodenum. It is commonly coded as 43235 for diagnostic purposes or as 43239 if a biopsy is performed.
When should endoscopy CPT code 43235 not be used?
Endoscopy CPT code 43235 should not be used if a therapeutic procedure, such as a biopsy (CPT 43239) or PEG tube placement (CPT 43246), is performed during the same session. In these cases, the more specific code should be used.
Can multiple endoscopy CPT codes be billed together?
Generally, only the most comprehensive endoscopy CPT code should be billed. However, if separate procedures are performed on different sites or for unrelated conditions, modifiers like XS or XU may be used to justify billing multiple codes.
