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Esophagogastroduodenoscopy (EGD) is a diagnostic and therapeutic procedure that involves the use of a flexible endoscope to visualize the upper gastrointestinal tract, which includes the esophagus, stomach, and duodenum. This procedure is particularly significant when it comes to addressing dysplastic or precancerous lesions, as well as small, early-stage cancerous lesions that are confined to the mucosal layer of these organs. The flexible endoscope is introduced through the mouth, allowing for a comprehensive examination of the velopharyngeal closure, the base of the tongue, and the hypopharynx. During the procedure, the physician assesses vocal cord motion and evaluates the pharyngeal musculature. As the endoscope is advanced, the patient may be instructed to perform actions such as burping or swallowing to facilitate the passage of the scope through the cricopharyngeus muscle. This careful maneuvering allows the endoscope to traverse the entire length of the esophagus, where any abnormalities can be identified. Once the endoscope reaches the stomach and duodenum, the mucosal surfaces are meticulously inspected. If a mucosal lesion is detected, the procedure can transition into an endoscopic mucosal resection (EMR), which involves marking the lesion's borders with electrocautery, injecting diluted adrenaline to separate the lesion from the underlying tissue, and ultimately excising the lesion using a snare. This combination of diagnostic and therapeutic techniques makes EGD with EMR a vital procedure in the management of upper gastrointestinal tract lesions.
© Copyright 2025 Coding Ahead. All rights reserved.
The esophagogastroduodenoscopy with endoscopic mucosal resection (CPT® Code 43254) is indicated for the following conditions:
The procedure begins with the introduction of a flexible endoscope through the patient's mouth. This allows for a thorough examination of the upper gastrointestinal tract. The physician first inspects the velopharyngeal closure, the base of the tongue, and the hypopharynx. Vocal cord motion is assessed, and the pharyngeal musculature is evaluated to ensure there are no abnormalities. As the endoscope is advanced, the patient may be asked to burp or swallow to facilitate the passage of the scope through the cricopharyngeus muscle. Once the endoscope successfully traverses the esophagus, the physician inspects the entire length for any abnormalities. Upon reaching the stomach, the endoscope is further advanced through the pylorus and into the duodenum, where mucosal surfaces are carefully inspected. If a mucosal lesion is identified, the physician marks the borders of the lesion using electrocautery to delineate the area for resection. Subsequently, diluted adrenaline is injected into the submucosal layer surrounding the lesion, which helps to separate the mucosal layer containing the lesion from the underlying muscle tissue. A snare equipped with a suction cup is then utilized to further detach the mucosal lesion from the surrounding tissue. Finally, the lesion is excised and captured using the snare, and the endoscope is withdrawn to complete the procedure.
After the esophagogastroduodenoscopy with endoscopic mucosal resection, patients are typically monitored for any immediate complications, such as bleeding or perforation. It is essential to provide post-procedure care instructions, which may include dietary modifications, activity restrictions, and signs of potential complications that should prompt immediate medical attention. Patients may experience some throat discomfort or mild sedation effects, which usually resolve shortly after the procedure. Follow-up appointments may be scheduled to discuss pathology results from the excised lesion and to determine any further treatment or surveillance that may be necessary.
| Short Descr | EGD ENDO MUCOSAL RESECTION | Medium Descr | EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION | Long Descr | Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection | 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 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | 1 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 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). | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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 | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Added | Added |
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