AHA Coding Clinic® for HCPCS - 2022 Issue 4; Ask the Editor

Reporting esophagogastroduodenoscopy (EGD) without examination of the small intestine

A patient with a known esophago-gastric anastomotic stricture presented for upper endoscopy. The scope was introduced through the mouth to the body of the stomach but not as far as the antrum and pylorus. A stricture was found at the esophageal anastomosis, which was traversed and dilated with a balloon dilator to 15mm. The duodenum was not examined. The EGD section of the CPT Codebook, advises when the duodenum is deliberately not examined to append modifier 52, Reduced Services. However, this advice is not applicable for facility reporting since anesthesia was used. Which CPT code and modifier, if applicable, should the facility use to report the upper endoscopy and dilation when examination of the duodenum was not intended? ...

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