2025 CPT code 43244
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophagogastroduodenoscopy Procedures Surgery Feed
Esophagogastroduodenoscopy (EGD) with band ligation of esophageal and/or gastric varices; a procedure using a flexible endoscope to place bands on enlarged blood vessels to prevent bleeding.
Modifiers may be applied as appropriate, such as modifier 52 (reduced services), 53 (discontinued procedure), or 76 (repeat procedure),depending on the specific circumstances of the procedure.
Medical necessity for this procedure is established by the presence of esophageal or gastric varices with high risk of bleeding (e.g., large varices, history of previous bleeding). The procedure aims to prevent potentially life-threatening hemorrhage.
The physician is responsible for performing the esophagogastroduodenoscopy, identifying varices, and performing the band ligation. This requires expertise in endoscopy and management of bleeding disorders.Pre-procedural assessment, post-procedural monitoring, and appropriate follow-up care are also the physician's responsibility.
In simple words: A thin, flexible tube with a camera (endoscope) is inserted through the mouth to view the esophagus and stomach.If there are enlarged blood vessels (varices) that could bleed, tiny rubber bands are placed around them to stop the bleeding.
Esophagogastroduodenoscopy (EGD), flexible, transoral, with band ligation of esophageal and/or gastric varices.This procedure involves inserting a flexible endoscope through the mouth to visualize the esophagus, stomach, and duodenum. Enlarged blood vessels (varices) in the esophagus or stomach are identified, and small rubber bands are placed around them to constrict and eventually eliminate the varices, thereby preventing bleeding.The procedure is typically performed under moderate sedation or general anesthesia.
Example 1: A 55-year-old male with a history of cirrhosis presents with hematemesis.EGD reveals large esophageal varices.Band ligation is performed to control the bleeding., A 60-year-old female with portal hypertension undergoes EGD which reveals multiple gastric varices.Selective band ligation is performed to prevent future hemorrhage., A 48-year-old patient with a history of alcohol abuse and suspected varices undergoes EGD as part of a diagnostic workup for recurrent gastrointestinal bleeding.Multiple esophageal varices are found and successfully treated with band ligation.
* Detailed history and physical examination noting symptoms of upper GI bleed (hematemesis, melena).* Complete endoscopic report including location, size, and number of varices treated.* Number of bands placed.* Documentation of pre-procedure and post-procedure vital signs and assessment.* Confirmation of medical necessity, especially if the procedure is performed electively.
** Accurate coding requires detailed documentation of the procedure, including the number of varices treated, location, and the use of any additional techniques.Any complications should also be documented.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: This information is not provided and would require accessing specific payer fee schedules and RVU data.
- Global Days: The global period for this procedure is not explicitly defined in the provided data.It would need to be determined based on payer-specific guidelines and the complexity of the case.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is not applicable to this procedure code.
- Fee Schedule: Fee schedules vary by payer and location. Historical fee data can be found through payer-specific fee schedules or publicly available databases (like those published by CMS).These vary substantially across locations and change over time.
- Specialties:Gastroenterology, Hepatology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)