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 2026.
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Book a Free Practice AuditWhat Is the CPT Code for an EGD?
Esophagogastroduodenoscopy (EGD) is an endoscopic procedure used to examine the upper gastrointestinal tract, including the esophagus, stomach, and duodenum. The EGD endoscopy CPT code differs from a lower procedure code endoscopy such as colonoscopy, so anatomy decides the code.
Esophagogastroduodenoscopy CPT Code List
| 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 2014. 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 2014. 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 |
EGD Procedure Codes at a Glance
Coders usually search by what was done rather than by code number. This maps the most common EGD procedures to their codes.
| Procedure | CPT Code |
|---|---|
| EGD diagnostic | 43235 |
| EGD with biopsy | 43239 |
| EGD with submucosal injection | 43236 |
| EGD with polypectomy, hot biopsy forceps | 43250 |
| EGD with polypectomy, snare | 43251 |
| EGD with EMR | 43254 |
| EGD with banding of esophageal varices | 43244 |
| EGD with injection sclerosis of varices | 43243 |
| EGD with control of bleeding | 43255 |
| EGD with foreign body removal | 43247 |
| EGD with stent placement | 43266 |
| EGD with ablation | 43270 |
| EGD with EUS, esophagus to duodenum | 43259 |
| EGD with EUS, limited | 43237 |
| EGD with PEG tube placement | 43246 |
Choosing the Right EGD Dilation Code
Dilation coding revolves around the methodology used and where the procedure happens rather than the actual diagnosis. The errors of selecting the wrong procedure code are very common. CPT 43248 is used when a guide wire is placed, and dilators are passed over the guide wire, while CPT 43249 is used for less-than-30mm transendoscopic balloon dilation.
A procedure under CPT 43233 is used when a balloon of 30mm or larger is utilized. The last code presented here, CPT 43245, is reserved in cases when the dilation is directed towards a duodenal or gastric stricture.
| Technique | CPT Code |
|---|---|
| Guide wire with dilators passed over it | 43248 |
| Esophageal balloon under 30 mm | 43249 |
| Esophageal balloon 30 mm or larger | 43233 |
| Gastric or duodenal stricture dilation | 43245 |
It is possible to report both a guide wire dilation and balloon dilation in the same session if the first procedure fails to produce the expected results. Check NCCI edits and payer policy before submitting them together, since this is one of the pairings most often flagged in gastroenterology billing services.
What Not to Bundle with EGD Codes
Two bundling rules cause most avoidable EGD rejections.
Therapeutic EGD codes replace the diagnostic code. When a therapeutic procedure such as biopsy, polypectomy, or dilation is performed, do not also report 43235 for the diagnostic exam. The therapeutic code already includes the diagnostic work.
Control of bleeding does not cover varices. Report 43255 for bleeding controlled by cautery, clips, or injection, but not for esophageal or gastric varices. Variceal treatment has its own codes: 43243 for injection sclerosis and 43244 for band ligation. Submucosal injection with 43236 is also not reported separately when the injection was part of controlling the bleeding.
Stent removal is not 43266. That code covers stent placement. When an existing esophageal stent is removed during an EGD, report the foreign body removal code 43247, since the stent is treated as a foreign body once it is being taken out. Check payer policy, as some plans have specific guidance on stent removal reporting.
Modifier 52: Reduced Services in Gastroenterology Procedures
Modifier 52 is used to report a partially reduced or incomplete procedure performed at the discretion of the gastroenterologist or physician. This modifier applies when the intended service is not fully completed, but the decision to stop is not based on patient risk.
When to Use Modifier 52:
Use modifier 52 when the physician has performed less than full service as planned, not because of any danger to the patient. In the case of EGD, one frequent example can be a planned esophagogastroduodenoscopy that was attempted, but the scope could not go through the stomach so that the duodenum could not be examined.
Scenario Example:
A physician begins a diagnostic EGD. Anatomy prevents the scope from reaching the duodenum, so the exam covers only the esophagus and stomach. The procedure was completed as far as it could go, with no patient risk involved.
- Correct Coding Format:
Use CPT code 43235 with modifier 52 to show the service was reduced. - Example: 43235-52, diagnostic EGD with the duodenum not examined.
Exception for 43266 and 43270: When pre-dilation, post-dilation, or guide wire procedure has not been performed, modifier 52 should not be added to stent placement or onto ablation. These procedures were included in the definition of the procedure under the definition ‘when performed’ and therefore, not using them will not make the service any less.
Modifier 53: Discontinued Procedure Due to Medical Risk
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. This kind of scenario is a common cause of claim denials if not coded properly.
Read more in our Denials and Rejections in Medical Billing guide. 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. Correct usage of XS modifier helps ensure full reimbursement for same-day multi-procedure cases, as explained in our Top 5 RCM Challenges in Healthcare.
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)
EGD Scenario:
A physician performs an EGD with biopsy of a gastric lesion. During the same session, a separate biopsy is taken from the distal esophagus for an unrelated clinical indication.
- How to Use: Modifier XU signals the second biopsy is distinct and does not overlap the first.
- Example: 43239 (EGD with biopsy) and the additional distinct service reported with XU appended, subject to payer and NCCI edits.
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. Our Medical Billing Services help ensure that preventive and diagnostic coding transitions are handled accurately, especially for Medicare claims.
- 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
The right procedure code for EGD sits inside the wider set of gastroenterology CPT codes, so 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. The right procedure code for EGD sits inside the wider set of gastroenterology CPT codes, so use these codes and modifiers accurately to reflect the specific circumstances of each procedure.
EGD Coding FAQs
43235 — a flexible, transoral examination of the esophagus, stomach, and duodenum, including specimen collection by brushing or washing. Therapeutic procedures instead use a code in the 43236–43270 range, which replaces the diagnostic code.43248 for guidewire dilation; 43249 for balloon dilation of the esophagus with a balloon under 30 mm; 43233 for balloon dilation of the esophagus with a 30 mm or larger balloon; and 43245 for dilation of gastric or duodenal strictures.XS applies. Reimbursement of the second endoscopy follows the specific payer’s guidelines.43235 is the diagnostic EGD with specimen collection by brushing or washing. 43239 is the EGD with biopsy, single or multiple. When a biopsy is taken, report 43239 instead of 43235 — not both.