Esophagogastroduodenoscopy: Hold Off Reporting 43255 Unless For Hemostasis

A potential $280 reimbursement could slip through your fingers if you fail to report control-of-bleeding correctly.

When your gastroenterologist performs EGD to control upper gastrointestinal bleeding, you might not look beyond a sole CPT® code to report the procedure.

Here's a case straight from a physician's operative report to illustrate:

Procedure: Esophagogastroduodenoscopy with submucosal injection of epinephrine and bipolar cauterization.

Indication for the procedure: Upper GI bleeding. Please see full dictated note dated September 15, 2011.

Medication: General anesthesia

Primary care physician: None

Findings: After informed consent was obtained and satisfactory cardiopulmonary assessment, a time-out as well as medication reconciliation was performed. The [...]

- Published on 2011-10-10