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tci General Surgery Coding Alert - 2020 Issue Q3

Reader Questions: Describe Symptom, Procedure EGD Details

Question: A patient was diagnosed with sliding hiatal hernia based on X-ray findings, and our surgeon performed an EGD. We billed the service as 43270 and got a denial. What could be the reason? Texas Subscriber Answer: First of all, the code you mention, 43270 (Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)), is for a lesion ablation, which you did not mention. There are other codes that may be more appropriate, such as 43235 (… diagnostic, including collection of specimen(s) by brushing or washing, when...

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