2025 CPT code 43255
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method.
Modifiers 52 (reduced services) and 53 (discontinued procedure) may apply if the duodenum is not examined.
Medical necessity for an EGD with bleeding control is established by the presence of symptoms or findings suggestive of upper gastrointestinal bleeding, such as hematemesis, melena, or hemodynamic instability.The procedure is necessary to diagnose and treat the source of bleeding.
The physician administers anesthesia, inserts the endoscope, advances it through the upper gastrointestinal tract (esophagus, stomach, and duodenum/jejunum as appropriate), and controls any bleeding encountered during the procedure using various techniques (chemical, electrocautery, heat probe, laser, or Argon plasma coagulation).
In simple words: This is a procedure where a thin, flexible tube with a camera on the end is inserted through the mouth to examine the esophagus, stomach, and the first part of the small intestine (duodenum). If there is any bleeding, the doctor will stop it during the procedure.
Esophagogastroduodenoscopy (EGD) is a procedure involving the insertion of a flexible endoscope through the mouth to visualize the esophagus, stomach, and duodenum.The procedure may include control of bleeding using various methods such as chemical cauterization, electrocautery, heat probe, laser, or argon plasma coagulation (APC).The scope is advanced (or attempted to be advanced) through the pylorus into the duodenum and/or jejunum as clinically indicated.Bleeding control is not separately reported if it occurs during the same operative session.
Example 1: A patient presents with suspected esophageal varices and active bleeding.The physician performs an EGD to visualize the varices and employs argon plasma coagulation to control the bleeding., A patient complains of dyspepsia and the physician orders an EGD to rule out peptic ulcer disease. During the procedure, a small area of bleeding is identified and controlled with electrocautery., A patient presents with hematemesis and melena. An EGD is performed to localize the source of bleeding. The physician finds a bleeding ulcer and controls bleeding using injection therapy.
* Pre-procedure and post-procedure vital signs.* Detailed description of the procedure performed, including the extent of the examination (esophagus, stomach, duodenum) and any findings.* Documentation of any bleeding encountered and the method(s) used to control it.* Histopathology results if biopsies were taken.* Photographs or videos of any lesions or abnormalities.* Patient's response to the procedure.
** The term "transoral" indicates that the endoscope is inserted through the mouth.Control of bleeding may involve multiple techniques.
- Revenue Code: P8B
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Gastroenterology, Surgery
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center