2025 CPT code 43235
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Esophagogastroduodenoscopy (EGD) for diagnostic purposes, including specimen collection by brushing or washing when performed.
Modifiers may be applicable to indicate specific circumstances, such as discontinued procedures or reduced services.
Medical necessity for an EGD is established by the presence of signs, symptoms, or conditions that warrant visualization and assessment of the upper gastrointestinal tract.
The physician administers anesthesia, inserts the endoscope, examines the digestive tract, collects specimens if needed, and withdraws the scope.
In simple words: A flexible, lighted tube is inserted through the mouth to examine the esophagus, stomach, and duodenum.The doctor may also collect tissue samples during the procedure.
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure). (Do not report 43235 in conjunction with 43197, 43198, 43210, 43236-43259, 43266, 43270, 43290, 43291, 43497, 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373, 44376, 44377, 44378, 44379)
Example 1: A patient presents with chronic heartburn and regurgitation. An EGD is performed to evaluate for gastroesophageal reflux disease (GERD) and collect biopsies to rule out Barrett's esophagus., A patient experiences difficulty swallowing. An EGD is performed to investigate the cause, such as a stricture or tumor., A patient has recurrent abdominal pain and vomiting. An EGD is performed to assess for ulcers, gastritis, or other abnormalities.
Documentation should include the reason for the EGD, findings during the procedure, any specimens collected, and any complications.
- Revenue Code: P8B
- Specialties:Gastroenterology, General Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office