43197 Trans nasal esophagoscopy 43198 Biospy Trans Nasal Esophagoscopy Esophagoscopy 43200 Esophagoscopy Includes collection of specimen(s) by brushing or washing, when performed. 43201 Submucosal injection Not separately reportable with varix injection, endoscopic mucosal resection or control of bleeding described by 43204, 43211, 43227 for the same lesion. 43202 Biopsy Do not report in conjunction with 43211 for the same lesion. 43204 Variceal injection Do not report in conjunction with 43201, 43227 for the same lesion. 43205 Band ligation Do not report in conjunction with 43227 for the same lesion. 43206 Optical endomicroscopy Do not report in conjunction with 88375. 43210 Esophagogastric fundoplasty New code for esophagogastric fundoplication, partial or complete. Includes duodenoscopy when performed. Do not report with 43197, 43200, 43235. 43215 Foreign body removal If fluroscopic guidance performed, use 76000. 43216 Hot biopsy or cautery 43217 Snare lesion removal Do not report in conjunction with 43211 for the same lesion. 43211 Endoscopic mucosal resection Report only when injection, banding AND lesion removal is performed. Do not report 43211 in conjunction with 43201, 43205, 43217 for the same lesion. 43212 Stent placement Stent placement includes dilation and guidewire passage. Do not report 43212 with codes 43220, 43226, 43241. If fluroscopic guidance performed, use 74360. 43220 Dilation with balloon <30mm If fluroscopic guidance performed, use 74360. For dilation without endoscopic visualization, see 43450, 43453. 43213 Retrograde dilation Do not report in conjunction with 74360, 76000, 76001. 43214 Dilation with balloon 30mm Includes imaging when performed. Do not report in conjunction with 74360, 76000, 76001. 43226 Guide wire insertion and dilation Do not report in conjunction with 43229 for the same lesion. Do not report in conjunction with 43212, 43220. If fluoroscopic guidance performed, use 74360. 43227 Control of bleeding, any method Do not report 43227 when bleeding occurs as a result of an endoscopic procedure. Do not report in conjunction with 43201, 43204, 43205 for the same lesion. 43229 Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with 43220, 43226 for the same lesion. 43231 Endoscopic ultrasound (EUS) Do not report in conjunction with 43232, 76975. 43232 Endoscopic ultrasound (EUS) with fine needle Do not report in conjunction with 43231, 76942, 76975. aspiration (FNA) 43499 Unlisted procedure, esophagus Unlisted procedure of the esophagus. 43235 EGD Includes collection of specimen(s) by brushing or washing, when performed. 43236 Submucosal injection Not separately reportable with varix injection, endoscopic mucosal resection or control of bleeding described by 43243, 43254, 43255 for the same lesion. 43237 Endoscopic ultrasound (EUS), limited Report if EUS performed is limited to esophagus, stomach OR duodenum. Do not report more than once per session. 43238 Endoscopic ultrasound (EUS), limited, with fineneedle aspiration (FNA) report more than once per session. Report if EUS performed is limited to esophagus, stomach OR duodenum. Do not 43239 Biopsy 43240 Pseudocyst drainage Includes placement of drain, stent, transmural needle aspiration and EUS. Not separately reportable with 43237, 43238, 43242, 43253, 43259. 43241 Tube or catheter insertion EGD Jan. 6, 1
EGD 43242 Endoscopic ultrasound (EUS) with fine needle Report only if EUS of esophagus, stomach AND duodenum is performed. aspiration (FNA) 43243 Sclerosis of varices Not separately reportable with submucosal injection and control of bleeding described by 43236, 43255 for the same lesion. 43244 Band ligation Not separately reportable with endoscopic mucosal resection or control of bleeding described by 43254, 43255 for the same lesion. 43245 Stricture dilation Use to report dilation of gastric, duodenal stricture. Not separately reportable with tumor ablation, stent placement described by 43266, 43270. 43246 Gastrostomy tube placement 43247 Foreign body removal 43248 Guide wire insertion and dilation Use to report dilation of esophageal stricture. Not separately reportable with stent placement, ablation described by 43266, 43270. 43249 Dilation with balloon <30mm Not separately reportable with ablation, stent placement described by 43270, 43266. 43233 Dilation with balloon 30mm Includes imaging, not separately reportable with 74360, 76000, 76001. 43250 Hot biopsy or bipolar cautery 43251 Snare lesion removal Not separately reportable with endoscopic mucosal resection described by 43254 for the same lesion. 43252 Optical endomicroscopy 43253 Ultrasound guided injection (e.g., fiducial marker, Not separately reportable with 43237, 43238, 43240, 43242, 43259, 76942, 76975. celiac axis injection) 43254 Endoscopic mucosal resection Report only when injection, banding AND lesion removal performed. Do not report in conjunction with 43236, 43239, 43244 or 43251 for same lesion. 43255 Control of bleeding Do not report in conjunction with 43236, 43243, 43244 for same lesion. 43266 Stent placement Stent placement includes dilation and guidewire passage. Do not report in conjunction with 43240, 43241, 43245, 43248, 43249 for same lesion. 43257 Thermal therapy to lower esophageal sphincter For ablation, see 43229, 43270. 43270 Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with 43248, 43249 for the same lesion. 43259 Endoscopic ultrasound (EUS) Report only if EUS of esophagus, stomach AND duodenum performed. Do not report in conjunction with 43237, 43240, 43242, 43253, 76975. 43999 Unlisted procedure, stomach Unlisted procedure of the stomach ERCP 43260 ERCP Includes collection of specimen(s) by brushing or washing, when performed. 43261 Biopsy 43262 Sphincterotomy/papillotomy May report if performed in addition to 43261, 43263, 43264, 43265, 43275, 43278. Do not report in conjunction with 43274 for stent placement or 43276 for stent exchange in the same location. Do not report in conjunction with 43277. 43263 Sphincter of Oddi pressure measurement Do not report more than once per session. 43264 Calculi/debris removal Includes removal of debris. Do not report if no calculi or debris found. Do not report in conjunction with stone destruction (lithotripsy) described by 43265. 43265 Lithotripsy Do not report in conjunction with 43264. 43274 Stent placement into biliary or pancreatic duct Do not report in conjunction with 43262, 43275, 43276, 43277 in the same duct. 43275 Foreign body/stent removal Do not report in conjunction with 43274, 43276. 43276 Removal and exchange of stent Do not report in conjunction with 43275. Do not report in conjunction with 43262, 43274 in the same duct. Jan. 6, 2
43277 Dilation with sphincteroplasty, sphincterotomy Do not report in conjunction with 43278 for the same lesion. Do not report in conjunction with 43262. Do not report for incidental dilation performed with 43264, 43265. Do not report in conjunction with 43274, 43276 in the same duct. 43278 Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with 43277 for the same lesion. 43273 Endoscopic papilla cannulation, visualization of Report once per procedure. pancreatic/ common bile duct(s) 47399 Unlisted procedure, liver Unlisted procedure of the liver. 47999 Unlisted procedure, biliary tree Unlisted procedure of the biliary tree. 48999 Unlisted procedure, pancreas Unlisted procedure of the pancreas. 43450 Esophagus dilation, unguided sound or bougie For radiological supervision and interpretation, use 74360. 43453 Dilation of esophagus over guide wire For radiological supervision and interpretation, use 74360 43460 Esophagogastric tamponade, with balloon (Sengstaken) Tubes 43752 Naso or oro gastric tube placement, requiring Do not report in conjunction with 76000, 76001. physician's skill and fluoroscopic placement 43753 Gastric intubation and aspiration(s), therapeutic, necessitating physician's skill 43754 Gastric intubation and aspiration, diagnostic, single specimen 43755 Gastric intubation and aspiration, collection of multiple specimens, includes drug administration 43756 Duodenal intubation and aspiration, diagnostic, single specimen 43757 Duodenal intubation and aspiration, collection of multiple speciments, includes drug administration 43760 Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance 43761 Repositioning of naso or oro gastric feeding tube, through the duodenum for enteric nutrition Do not report in conjunction with 44500, 49446. If imaging guidance is performed, use 76000. 44500 Introduction of long gastrointestinal tube (e.g. For radiological supervision and interpretation, use 74340. Miller Abbott) Endoscopy, Small Intestine Not including ileum 44360 Small intestinal enteroscopy, not including ileum 44361 Biopsy 44363 Foreign body removal 44364 Snare polypectomy 44365 Hot biopsy 44366 Control of bleeding 44369 Ablation 44370 Stent placement 44372 Percutaneous jejunostomy tube 44373 Conversion of PEG to PEJ ERCP Esophageal Manipulation Jan. 6, 3
44376 Small intestinal enteroscopy, including ileum 44377 Biopsy 44378 Control of bleeding 44379 Stent placement Endoscopy, Small Intestine Including ileum Ileoscopy 44380 Ileoscopy Includes collection of specimen(s) by brushing or washing, when performed. 44382 Biopsy 44381 Balloon dilation Report new code 44381 with modifier 59 for each additional stricture dilated. Do not report in conjunction with 44384 for the same lesion. Use 74360 if fluoroscopic guidance is performed. 44384 Stent placement Stent placement includes dilation and guidewire passage. Not separately reportable with 44381. Use 74360 if fluoroscopic guidance is performed. Pouchoscopy 44385 Pouchoscopy Terminology updated to include Kock pouch and ileal reservoir [S or J] as examples. Includes collection of specimen(s) by brushing or washing, when performed. 44386 Biopsy Changes in colonoscopy guidelines section Colonoscopy through Stoma Colonoscopy through stoma is now defined as the examination of the colon, from the colostomy stoma to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis. When performing an endoscopic procedure on a patient who is scheduled and prepared for a colonoscopy through stoma, if the physician is unable to advance the colonoscope to the cecum or colonsmall intestine anastomosis due to unforeseen circumstances, report 44388 with modifier 53 with appropriate documentation. For therapeutic exams that do not reach the colon small intestine anastomosis, report the appropriate colonoscopy through stoma code with modifier 52 with appropriate documentation. 44388 Colonoscopy through stoma Includes collection of specimen(s) by brushing or washing, when performed. 44389 Biopsy 44390 Foreign body removal Use 76000 if fluoroscopic guidance performed. 44391 Control of bleeding Do not report in conjunction with 44404 for same lesion. 44392 Hot biopsy 44401 Ablation Ablation includes dilation and guidewire passage. Do not report in conjunction with 44405 for the same lesion. 44394 Snare Do not report in conjunction with 44403, endoscopic mucosal resection, for the same lesion. 44402 Stent placement Stent placement includes dilation and guidewire passage. Do not report in conjunction with 44405. Use 74360 if fluoroscopic guidance is performed. 44403 Endoscopic mucosal resection (EMR) Report only when injection, banding AND lesion removal performed. Do note report in conjunction with biopsy, submucosal injection or snare described by 44389, 44394, 44404 for the same lesion. 44404 Submucosal injection Do not report in conjunction with 44391, 44403 for the same lesion. 44405 Balloon dilation Do not report in conjunction with 44401, 44402. Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Use 74360 if fluoroscopic guidance is performed. 44406 Endoscopic ultrasound (EUS) Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Do not report in conjunction with 44407 or 76975. Report only once per session. Jan. 6, 4
Colonoscopy through Stoma 44407 Endoscopic ultrasound (EUS) with FNA Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Do not report in conjunction with 44406, 76942, 76975. Report only once per session. 44408 Decompression Includes placement of decompression tube when performed. Report only once per session. 44799 Unlisted procedure, small intestine Unlisted procedure of the small intestine. Flexible Sigmoidoscopy 45330 Flexible sigmoidoscopy Includes collection of specimen(s) by brushing or washing, when performed. 45331 Biopsy Do not report in conjunction with 45349 for the same lesion. 45332 Foreign body removal Use 76000 if fluoroscopic guidance is performed. 45333 Hot biopsy 45334 Control of bleeding Do not report in conjunction with 45335, 45350 for same lesion. Flexible Sigmoidoscopy 45335 Submucosal injection Do not report in conjunction with 45334, 45349 for the same lesion. 45337 Decompression Includes placement of decompression tube when performed. Report only once per session. 45338 Snare Do not report in conjunction with 45349 for the same lesion. 45346 Ablation Ablation includes dilation and guidewire passage, if performed. Do not report in conjunction with 45340 for the same lesion. 45340 Dilation Do not report in conjunction with 45346, 45347. Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Use 74360 if fluoroscopic guidance is performed. 45341 Endoscopic ultrasound (EUS) Do not report in conjunction with 45342, 76872, 76975. Report only once per session. 45342 Endoscopic ultrasound (EUS) with FNA Do not report in conjunction with 45341, 76872, 76942, 76975. Report only once per session. 45347 Stent placement Stent placement includes dilation and guidewire passage, if performed. Do not report in conjunction with 45340. Use 74360 if fluoroscopic guidance performed. 45349 Endoscopic mucusal resection (EMR) Report only when injection, banding AND lesion removal performed. Do not report in conjunction with 45331, 45335, 45338, 45350 for the same lesion. 45350 Band ligation Do not report in conjunction with 45334 for the same lesion. Do not report in conjunction with 45349, 46221. To report control of active bleeding with band ligation, use 45334. Colonoscopy Changes in definition of colonoscopy Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis. When performing a diagnostic or screening endoscopic procedure on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon small intestine anastomosis, report 45378 with modifier 53 and provide appropriate documentation. For therapeutic colonoscopy, report modifier 52 and provide appropriate documentation. 45378 Colonscopy Includes collection of specimen(s) by brushing or washing, when performed. 45379 Foreign body Use 76000 if fluoroscopic guidance is performed. 45380 Biopsy Do not report in conjunction with 45390 for the same lesion. 45381 Submucosal injection Do not report in conjunction with 45382, 45390 for the same lesion 45382 Control of bleeding Do not report in conjunction with 45381, 45398 for the same lesion. Hemorrhoids described by 45381, 45398 for same lesion. Jan. 6, 5
45388 Ablation Ablation includes dilation and guidewire passage, when performed. Do not report in conjunction with 45386 for the same lesion. 45384 Hot biopsy 45385 Snare Do not report in conjunction with 45390 for the same lesion. 45386 Dilation Do not report in conjunction with 45388, 45389. Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Use 74360 if fluoroscopic guidance performed. 45389 Stent placement Stent placement includes dilation and guidewire passage, when performed. Do not report in conjunction with 45386. Use 74360 if fluoroscopic guidance performed. 45391 Endoscopic ultrasound (EUS) Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Report only once per session. Do not report in conjunction with 45392, 76872, 76975. 45392 Endoscopic ultrasound (EUS) with FNA Specifies exam limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. Do not report in conjunction with 45381, 76872, 76942, 76975. Report only once per session. 45390 Endoscopic mucosal resection (EMR) Report only when injection, banding AND lesion removal performed. Do not report in conjunction with 45380, 45381, 45385, 45398 for the same lesion. 45393 Decompression Includes placement of decompression tube placement when performed. Report only once per session. 45398 Band ligation Do not report in conjunction with 45382 for the same lesion. Do not report in conjunction with 45390, 46221. To report control of active bleeding with band ligation, use 45382. Do not report more than once per session. 45399 Unlisted procedure, colon Unlisted procedure of the colon. 45999 Unlisted procedure, rectum Unlisted procedure of the rectum. Anus 46221 Hemorrhoidectomy, internal, by rubber band Do not report in conjunction with 45350, 45398. ligation 46600 Anoscopy, diagnostic Includes collection of specimen(s) by brushing or washing, when performed. 46930 Destruction of internal hemorrhoid(s) by thermal energy 46999 Unlisted procedure, anus Abdominal Procedures 47000 Biopsy of liver, needle, percutaneous 49082 Abdominal paracentesis, without imaging guidance Abdominal Procedures 49083 With imaging guidance Do not report in conjunction with 76942, 77002, 77012, 77021. 95980 Electronic analysis of implanted neurostimulatory pulse generator system; intraoperative, with programming 95981 Subsequent, without reprogramming 95982 Subsequent, with reprogramming 78267 Helicobacter pylori urea breath test, C 14, acquisition for analysis 78268 Analysis 83013 Helicobacter pylori, breath test analysis, C 13 83014 Drug administration Colonoscopy Gastric Neurostimulators Gastrointestinal Diagnostic Procedures Jan. 6, 6
Gastrointestinal Diagnostic Procedures 91010 Esophageal motility 91013 Esophageal motility, with stimulation or Do not report more than once per session. perfusion 91020 Gastric motility Do not report in conjunction with 91112. 91022 Duodenal motility Do not report in conjunction with 91112. 91030 Esophagus, acid perfusion 91034 Esophagus, gastroesophageal reflux test, with nasal catheter ph electrode(s) placement 91035 Esophagus, gastroesophageal reflux test, with mucosal attached telemetry ph electrode placement 91037 Esophageal function test, with nasal catheter impedance electrode(s) placement 91038 Esophageal function test, with nasal catheter impedance electrode(s) placement, prolonged 91040 Esophageal balloon distension study Revised to 'with provocation, when performed.' 91065 Breath hydrogen or methane test Report once for each administered challenge. 91110 Gastrointestinal tract imaging, intraluminal, Append modifier 52 if ileum not visualized. Do not report in conjunction with 91111. esophagus through ileum 91111 Gastrointestinal tract imaging, intraluminal, Do not report in conjunction with 91110. esophagus 91112 Gastrointestinal transit and pressure Do not report in conjunction with 91020, 91022, 91117. measurement, stomach through colon, wireless capsule 91117 Colon motility, including provocation tests if Do not report in conjunction with 91120, 91122. performed 91120 Rectal sensation, tone and compliance test Do not report in conjunction with 91117. 91122 Anorectal manometry Do not report in conjunction with 91117. 91132 Electrogastrography (EGG), diagnostic 91133 EGG, with provocative testing 91200 Liver elastography 91299 Unlisted diagnostic gastroenterology procedure Photodynamic Therapy 96570 Photodynamic therapy; first 30 minutes Report with modifier 52 for service of less than 23 minutes. 96571 Each additional 15 minutes Infusion Therapy 96360 Hydration, initial, 31 60 minutes 96361 Each additional hour Report for intervals of greater than 30 minutes beyond one hour increments. 96365 Intravenous infusion, up to 1 hour 96366 Each additional hour Report for intervals of greater than 30 minutes beyond one hour increments. 96372 Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscular 96374 Intravenous push, single or initial substance/drug 96375 Each additional sequential intravenous push of a new substance/drug 96413 Chemotherapy administration, intravenous infusion, up to one hour Infusion Therapy Jan. 6, 7
96415 Each additional hour Report for intervals of greater than 30 minutes beyond one hour increments. 90911 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry Biofeedback Jan. 6, 8