Coding guidelines for Endoscopy

Digestive System CPT Codes 

Endoscopic Services

Endoscopy procedure can be performed in many POS

• Office 
• Outpatient   
• ambulatory surgical centers (ASC) 

Surgical endoscopy includes diagnostic endoscopy.

A diagnostic endoscopy HCPCS/CPT code shall not be reported with a surgical endoscopy code.

Procedures like venous access, infusion and injection, non-invasive oximetry, anesthesia provided during endoscopy procedures are considered as part of the procedure.

 When a biopsy is performed and followed by excision/ destruction/removal of the biopsied lesion, then the biopsy is considered as part of the procedure should not be billed separately

If multiple endoscopic services are performed, the most comprehensive code describing the service(s) rendered shall be reported. If multiple services are performed and not adequately described by a single HCPCS/CPT code, more than one code may be reported. The multiple procedure modifier 51 should be appended to the secondary HCPCS/CPT code. Only medically necessary services may be reported. Incidental examination of other areas shall not be reported separately.

If the same endoscopic procedure (e.g., polypectomy) is performed multiple times at a single patient encounter in the same region as defined by the “CPT Manual” narrative, only one CPT code may be reported with one unit of service.

Gastroenterological procedures included in CPT code ranges 43753-43757 and 91010-91299 are frequently complementary to endoscopic procedures.

Esophageal and gastric washings for cytology when performed are integral components of an esophagogastroduodenoscopy (e.g., CPT code 43235).

Gastric or duodenal intubation with or without aspiration (e.g., CPT codes 43753, 43754, 43756) shall not be separately reported when performed as part of an upper gastrointestinal endoscopic procedure

Gastric or duodenal stimulation testing (e.g., CPT codes 43755, 43757) may be facilitated by gastrointestinal endoscopy (e.g., procurement of gastric or duodenal specimens).

When performed concurrent with an upper gastrointestinal endoscopy, CPT code 43755 or 43757 should be reported with modifier 52 indicating that a reduced level of service was performed.

If an endoscopy or enteroscopy is performed as a common standard of practice when performing another service, the endoscopy or enteroscopy is not separately reportable. For example, if a small intestinal endoscopy or enteroscopy is performed during the creation or revision of an enterostomy, the small intestinal endoscopy or enteroscopy is not separately reportable. An endoscopy to assess anatomic landmarks or assess extent of disease preceding another surgical procedure at the same patient encounter is not separately reportable. However, an endoscopic procedure for diagnostic purposes to decide whether a more extensive open procedure needs to be performed is separately reportable. . In the latter situation, modifier 58 may be used to indicate that the diagnostic endoscopy and more extensive open procedure were staged procedures.

If an endoscopic procedure is performed at the same patient encounter as a non-endoscopic procedure to ensure no intraoperative injury occurred or verify the procedure was performed correctly, the endoscopic procedure is not separately reportable with the non-endoscopic procedure

If a non-endoscopic esophageal dilation (e.g., CPT codes 43450, 43453) fails and is followed by an endoscopic esophageal dilation procedure (e.g., CPT codes 43213, 43214, 43233), only the endoscopic esophageal dilation procedure may be reported. The provider/supplier shall not report the failed procedure.

If it is necessary to perform diagnostic or surgical endoscopy of the hepatic/biliary/pancreatic system using different methodologies (e.g., biliary T-tube endoscopy, ERCP) multiple CPT codes may be reported. Modifier 51 should be appended to indicate that multiple procedures were performed at the same patient encounter

Intubation of the gastrointestinal tract (e.g., percutaneous placement of G-tube) includes subsequent non-endoscopic removal of the tube. CPT codes such as 43247 (Upper gastrointestinal endoscopic removal of foreign body(s)) shall not be reported for non-endoscopic removal of previously placed therapeutic devices. However, if a previously placed therapeutic device must be removed endoscopically because it cannot be removed by a non-endoscopic procedure, a CPT code such as 43247 may be reported for the endoscopic removal

Control of bleeding is an integral component of endoscopic procedures and is not separately reportable. For example, if a provider/supplier performs endoscopic band ligation(s) by flexible sigmoidoscopy (CPT code 45350) or colonoscopy (CPT code 45398), control of bleeding is not separately reportable with CPT codes 45334 (Flexible sigmoidoscopic control of bleeding) or 45382 (Colonoscopic control of bleeding) respectively

If it is necessary to repeat an endoscopy to control bleeding at a separate patient encounter on the same date of service, the HCPCS/CPT code for endoscopy for control of bleeding is separately reportable with modifier 78 indicating that the procedure required return to the operating room (or endoscopy suite) for a related procedure during the postoperative period.

Only the more extensive endoscopic procedure may be reported for a patient encounter. For example, if a sigmoidoscopy is completed and the physician also performs a colonoscopy during the same patient encounter, only the colonoscopy may be reported.

If an endoscopic procedure fails and is converted into an open procedure at the same patient encounter, only the open procedure is reportable. Neither a surgical endoscopy nor diagnostic endoscopy procedure code shall be reported with the open procedure code when an endoscopic procedure is converted to an open procedure.

Coding guidelines for Endoscopy.

If the larynx is viewed through an esophagoscope or upper gastrointestinal endoscope during endoscopy, a laryngoscopy CPT code cannot be reported separately. However, if a medically necessary laryngoscopy is performed with a separate laryngoscope, the laryngoscopy and esophagoscopy (or upper gastro-intestinal endoscopy) CPT codes may be reported with NCCI PTP-associated modifiers.

Inclusive Procedure

Fluoroscopy (CPT code 76000) is an integral component of all endoscopic procedures when performed. CPT code 76000 shall not be reported separately with an endoscopic procedure. For example, fluoroscopy (e.g., CPT code 76000) is not separately reportable with CPT codes describing gastrointestinal endoscopy for foreign body removal (e.g., 43194, 43215, 43247, 44390, 45332, 45379).

If a transabdominal colonoscopy via colostomy and/or standard sigmoidoscopy or colonoscopy is performed as a necessary part of an open procedure (e.g., colectomy), the endoscopic procedure(s) is (are) not separately reportable. However, if either endoscopic procedure is performed as a diagnostic procedure upon which the decision to perform the open procedure is made, the endoscopic procedure may be reported separately. Modifier 58 may be used to indicate that the diagnostic endoscopy and the open procedure were staged or planned services.

flexible transoral esophagoscopy with balloon dilation [less than 30 mm diameter], use 43220)

If an endoscope can’t be advanced at least 50 cm beyond the pylorus – Code as Esophagogastroduodenoscopy code 44799

 Stomal, Endoscopy 

Examination of the intestine via the stoma

·        Ileoscopy through a stoma (44380 – 44384)

·         Colonoscopy through a stoma (44388 – 44408)

 Proctosigmoidoscopy  CPT codes: 45300 – 45327

 Examination of the rectum and may include the examination of a portion of the sigmoid colon

Sigmoidoscopy  CPT codes: 45330 – 45347

– Examination of the rectum and sigmoid colon and may include the examination of a portion of the descending colon

Colonoscopy  CPT codes: 45378 – 45398

– Examination of the entire colon (Rectum to Cecum) may include the examination of the terminal ileum