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An esophagogastroduodenoscopy (EGD) is a specialized upper gastrointestinal (UGI) endoscopic procedure that allows for the examination of the esophagus, stomach, duodenum, and/or jejunum. This procedure is performed using a flexible, transoral endoscope, which is a thin, lighted tube equipped with a camera that provides direct visualization of the upper GI tract. The primary purpose of this procedure is to assess and treat conditions such as esophageal and gastric varices, which are dilated blood vessels that can develop in the esophagus and stomach, often as a result of portal hypertension due to liver cirrhosis. During the EGD, the patient’s mouth and throat are numbed with an anesthetic spray to minimize discomfort. A hollow mouthpiece is then placed in the mouth to facilitate the insertion of the endoscope. As the patient swallows, the endoscope is carefully advanced through the esophagus, allowing the physician to inspect the esophageal lining for any abnormalities. The procedure continues as the endoscope is passed into the stomach, where air is insufflated to expand the stomach for better visualization. The physician examines various regions of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, noting any irregularities. The endoscope is further advanced through the pylorus into the duodenum and/or jejunum, where the mucosal surfaces are also inspected. In the context of CPT® Code 43243, the procedure includes the injection of a sclerosing solution directly into the esophageal and/or gastric varices, which serves to shrink these abnormal blood vessels and reduce the risk of bleeding. This procedure is critical for managing complications associated with portal hypertension and ensuring patient safety.
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The esophagogastroduodenoscopy (EGD) with injection sclerosis is indicated for the following conditions:
The procedure for esophagogastroduodenoscopy with injection sclerosis involves several key steps:
After the esophagogastroduodenoscopy with injection sclerosis, the patient is monitored for any immediate complications, such as bleeding or adverse reactions to the anesthetic. Recovery typically involves observation in a medical facility until the effects of the anesthesia wear off. Patients may experience a sore throat or mild discomfort following the procedure, which usually resolves quickly. It is important for patients to follow any post-procedure instructions provided by their healthcare provider, including dietary modifications and activity restrictions, to ensure proper recovery and minimize complications.
| Short Descr | EGD INJECTION VARICES | Medium Descr | EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES | Long Descr | Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | 1 | CCS Clinical Classification | 68 - Injection or ligation of esophageal varices |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AG | Primary physician | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Changed | Description Changed |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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