LCD for Diagnostic and Therapeutic Esophagogastroduodenoscopy (L29167)
Coding Information for CPT/HCPCS Codes
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
99999 Not Applicable
43235
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
43236
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY
SUBSTANCE
43237
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED
TO THE ESOPHAGUS
43238
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED
INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S),
ESOPHAGUS (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION
LIMITED TO THE ESOPHAGUS)
43239
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE
43241
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH TRANSENDOSCOPIC INTRALUMINAL TUBE OR
CATHETER PLACEMENT
43243
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL AND/OR
GASTRIC VARICES
43244
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BAND LIGATION OF ESOPHAGEAL AND/OR GASTRIC
VARICES
43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR OBSTRUCTION
(EG, BALLOON, GUIDE WIRE, BOUGIE)
43246
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCUTANEOUS
GASTROSTOMY TUBE
43247
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF FOREIGN BODY
43248
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION
OF ESOPHAGUS OVER GUIDE WIRE
43249
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30
MM DIAMETER)
43250
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
43251
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) BY SNARE TECHNIQUE
43255
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH CONTROL OF BLEEDING, ANY METHOD
43258
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS,
BIPOLAR CAUTERY OR SNARE TECHNIQUE
ICD-9 Codes that Support Medical Necessity
040.2 WHIPPLE'S DISEASE
112.84 CANDIDAL ESOPHAGITIS
150.0 -
152.9 opens in
new window
MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS -
MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED
SITE
155.0 MALIGNANT NEOPLASM OF LIVER PRIMARY
156.0 -
156.9 opens in
new window
MALIGNANT NEOPLASM OF GALLBLADDER - MALIGNANT
NEOPLASM OF BILIARY TRACT PART UNSPECIFIED SITE
157.0 -
157.9 opens in new window
MALIGNANT NEOPLASM OF HEAD OF PANCREAS - MALIGNANT
NEOPLASM OF PANCREAS PART UNSPECIFIED
159.8 MALIGNANT NEOPLASM OF OTHER SITES OF DIGESTIVE
SYSTEM AND INTRA-ABDOMINAL ORGANS
176.3 KAPOSI'S SARCOMA GASTROINTESTINAL SITES
197.4 SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE
INCLUDING DUODENUM
197.6 SECONDARY MALIGNANT NEOPLASM OF RETROPERITONEUM
AND PERITONEUM
198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED
SITES
202.80 OTHER MALIGNANT LYMPHOMAS UNSPECIFIED SITE
211.0 -
211.9 opens in
new window
BENIGN NEOPLASM OF ESOPHAGUS - BENIGN NEOPLASM OF
OTHER AND UNSPECIFIED SITE IN THE DIGESTIVE SYSTEM
214.3 LIPOMA OF INTRA-ABDOMINAL ORGANS
214.9 LIPOMA UNSPECIFIED SITE
215.9 OTHER BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT
TISSUE SITE UNSPECIFIED
228.04 HEMANGIOMA OF INTRA-ABDOMINAL STRUCTURES
230.1 -
230.8 opens in
new window
CARCINOMA IN SITU OF ESOPHAGUS - CARCINOMA IN SITU OF
LIVER AND BILIARY SYSTEM
235.2 -
235.4 opens in
new window
NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH
INTESTINES AND RECTUM - NEOPLASM OF UNCERTAIN
BEHAVIOR OF RETROPERITONEUM AND PERITONEUM
239.0 NEOPLASM OF UNSPECIFIED NATURE OF DIGESTIVE SYSTEM
251.5 ABNORMALITY OF SECRETION OF GASTRIN
261 NUTRITIONAL MARASMUS
263.0 -
263.9 opens in
new window
MALNUTRITION OF MODERATE DEGREE - UNSPECIFIED
PROTEIN-CALORIE MALNUTRITION
280.0 -
280.9 opens in
new window
IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS
(CHRONIC) - IRON DEFICIENCY ANEMIA UNSPECIFIED
285.1 ACUTE POSTHEMORRHAGIC ANEMIA
300.11 CONVERSION DISORDER
306.4 GASTROINTESTINAL MALFUNCTION ARISING FROM MENTAL
FACTORS
307.1 ANOREXIA NERVOSA
307.50 EATING DISORDER UNSPECIFIED
307.51 BULIMIA NERVOSA
307.52 PICA
307.53 RUMINATION DISORDER
307.54 PSYCHOGENIC VOMITING
438.82 DYSPHAGIA CEREBROVASCULAR DISEASE
447.2 RUPTURE OF ARTERY
448.0 HEREDITARY HEMORRHAGIC TELANGIECTASIA
456.0 ESOPHAGEAL VARICES WITH BLEEDING
456.1 ESOPHAGEAL VARICES WITHOUT BLEEDING
456.20 -
456.21 opens in
new window
ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE
WITH BLEEDING - ESOPHAGEAL VARICES IN DISEASES
CLASSIFIED ELSEWHERE WITHOUT BLEEDING
507.0 PNEUMONITIS DUE TO INHALATION OF FOOD OR VOMITUS
530.0 -
530.89 opens in
new window
ACHALASIA AND CARDIOSPASM - OTHER DISEASES OF
ESOPHAGUS
531.00 -
531.91 opens in
new window
ACUTE GASTRIC ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - GASTRIC ULCER UNSPECIFIED AS ACUTE OR
CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
532.00 -
532.91 opens in
new window
ACUTE DUODENAL ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - DUODENAL ULCER UNSPECIFIED AS ACUTE OR
CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
533.00 -
533.91 opens in
new window
ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH
HEMORRHAGE WITHOUT OBSTRUCTION - PEPTIC ULCER OF
UNSPECIFIED SITE UNSPECIFIED AS ACUTE OR CHRONIC
WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
534.00 -
534.91 opens in
new window
ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - GASTROJEJUNAL ULCER UNSPECIFIED AS
ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR
PERFORATION WITH OBSTRUCTION
535.00 -
535.71 opens in
new window
ACUTE GASTRITIS (WITHOUT HEMORRHAGE) - EOSINOPHILIC
GASTRITIS, WITH HEMORRHAGE
536.1 ACUTE DILATATION OF STOMACH
536.2 PERSISTENT VOMITING
536.3 GASTROPARESIS
536.40 -
536.49 opens in
new window
GASTROSTOMY COMPLICATION UNSPECIFIED - OTHER
GASTROSTOMY COMPLICATIONS
536.8 DYSPEPSIA AND OTHER SPECIFIED DISORDERS OF FUNCTION
OF STOMACH
537.0 -
537.89 opens in
new window
ACQUIRED HYPERTROPHIC PYLORIC STENOSIS - OTHER
SPECIFIED DISORDERS OF STOMACH AND DUODENUM
538 GASTROINTESTINAL MUCOSITIS (ULCERATIVE)
551.3 DIAPHRAGMATIC HERNIA WITH GANGRENE
552.3 -
552.8 opens in
new window
DIAPHRAGMATIC HERNIA WITH OBSTRUCTION - HERNIA OF
OTHER SPECIFIED SITES WITH OBSTRUCTION
553.3 DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR
GANGRENE
555.0 -
555.9 opens in
new window
REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL
ENTERITIS OF UNSPECIFIED SITE
560.9 UNSPECIFIED INTESTINAL OBSTRUCTION
562.01 DIVERTICULITIS OF SMALL INTESTINE (WITHOUT
HEMORRHAGE)
562.02 DIVERTICULOSIS OF SMALL INTESTINE WITH HEMORRHAGE
562.03 DIVERTICULITIS OF SMALL INTESTINE WITH HEMORRHAGE
569.62 MECHANICAL COMPLICATION OF COLOSTOMY AND
ENTEROSTOMY
569.71 -
569.79 opens in
new window
POUCHITIS - OTHER COMPLICATIONS OF INTESTINAL POUCH
569.82 ULCERATION OF INTESTINE
569.87 VOMITING OF FECAL MATTER
571.1 ACUTE ALCOHOLIC HEPATITIS
571.2 ALCOHOLIC CIRRHOSIS OF LIVER
571.3 ALCOHOLIC LIVER DAMAGE UNSPECIFIED
571.40 CHRONIC HEPATITIS UNSPECIFIED
571.41 CHRONIC PERSISTENT HEPATITIS
571.42 AUTOIMMUNE HEPATITIS
571.49 OTHER CHRONIC HEPATITIS
571.5 CIRRHOSIS OF LIVER WITHOUT ALCOHOL
571.6 BILIARY CIRRHOSIS
572.3 PORTAL HYPERTENSION
574.00 -
574.01 opens in
new window
CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER WITH
ACUTE CHOLECYSTITIS WITH OBSTRUCTION
574.10 -
574.11 opens in
new window
CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER WITH
OTHER CHOLECYSTITIS WITH OBSTRUCTION
574.20 -
574.21 opens in
new window
CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER
WITHOUT CHOLECYSTITIS WITH OBSTRUCTION
574.30 -
574.31 opens in
new window
CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF BILE DUCT WITH
ACUTE CHOLECYSTITIS WITH OBSTRUCTION
574.40 -
574.41 opens in
new window
CALCULUS OF BILE DUCT WITH OTHER CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF BILE DUCT WITH
OTHER CHOLECYSTITIS WITH OBSTRUCTION
575.0 ACUTE CHOLECYSTITIS
575.5 FISTULA OF GALLBLADDER
576.0 POSTCHOLECYSTECTOMY SYNDROME
576.4 FISTULA OF BILE DUCT
577.0 ACUTE PANCREATITIS
577.1 CHRONIC PANCREATITIS
577.2 CYST AND PSEUDOCYST OF PANCREAS
578.0 -
578.9 opens in
new window
HEMATEMESIS - HEMORRHAGE OF GASTROINTESTINAL TRACT
UNSPECIFIED
579.0 -
579.9 opens in
new window
CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION
694.0 DERMATITIS HERPETIFORMIS
710.1 SYSTEMIC SCLEROSIS
747.61 GASTROINTESTINAL VESSEL ANOMALY
750.3 CONGENITAL TRACHEOESOPHAGEAL FISTULA ESOPHAGEAL
ATRESIA AND STENOSIS
750.4 OTHER SPECIFIED CONGENITAL ANOMALIES OF ESOPHAGUS
750.5 CONGENITAL HYPERTROPHIC PYLORIC STENOSIS
750.6 CONGENITAL HIATUS HERNIA
750.7 OTHER SPECIFIED CONGENITAL ANOMALIES OF STOMACH
783.0 ANOREXIA
783.21 -
783.3 opens in
new window
LOSS OF WEIGHT - FEEDING DIFFICULTIES AND
MISMANAGEMENT
784.42 DYSPHONIA
784.43 HYPERNASALITY
784.44 HYPONASALITY
784.49 OTHER VOICE AND RESONANCE DISORDERS
784.52 FLUENCY DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE
784.91 -
784.99 opens in
new window
POSTNASAL DRIP - OTHER SYMPTOMS INVOLVING HEAD AND
NECK
786.2 COUGH
786.50 -
786.59 opens in
new window
UNSPECIFIED CHEST PAIN - OTHER CHEST PAIN
786.6 SWELLING MASS OR LUMP IN CHEST
787.01 -
787.91 opens in
new window
NAUSEA WITH VOMITING - DIARRHEA
789.00 -
789.09 opens in
new window
ABDOMINAL PAIN UNSPECIFIED SITE - ABDOMINAL PAIN OTHER
SPECIFIED SITE
789.30 -
789.39 opens in
new window
ABDOMINAL OR PELVIC SWELLING MASS OR LUMP
UNSPECIFIED SITE - ABDOMINAL OR PELVIC SWELLING MASS
OR LUMP OTHER SPECIFIED SITE
789.51 -
789.59 opens in
new window
MALIGNANT ASCITES - OTHER ASCITES
789.60 -
789.69 opens in
new window
ABDOMINAL TENDERNESS UNSPECIFIED SITE - ABDOMINAL
TENDERNESS OTHER SPECIFIED SITE
790.5 OTHER NONSPECIFIC ABNORMAL SERUM ENZYME LEVELS
790.99 OTHER ABNORMAL FINDINGS ON EXAMINATION OF BLOOD
792.1 NONSPECIFIC ABNORMAL FINDINGS IN STOOL CONTENTS
793.4 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND
OTHER EXAMINATION OF GASTROINTESTINAL TRACT
793.6
NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND
OTHER EXAMINATION OF ABDOMINAL AREA, INCLUDING
RETROPERITONEUM
799.4 CACHEXIA
862.22 INJURY TO ESOPHAGUS WITHOUT OPEN WOUND INTO CAVITY
874.4 -
874.5 opens in
new window
OPEN WOUND OF PHARYNX WITHOUT COMPLICATION - OPEN
WOUND OF PHARYNX COMPLICATED
935.1 -
935.2 opens in
new window
FOREIGN BODY IN ESOPHAGUS - FOREIGN BODY IN STOMACH
936 FOREIGN BODY IN INTESTINE AND COLON
938 FOREIGN BODY IN DIGESTIVE SYSTEM UNSPECIFIED
947.0 BURN OF MOUTH AND PHARYNX
947.2 -
Diagnoses that Support Medical Necessity
N/A
ICD-9 Codes that DO NOT Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
* According to the ICD-9-CM book, diagnosis codes E864.1, E864.2, E864.3, E864.4 and E961 are secondary diagnosis codes and should not be billed as the primary diagnosis.
947.3 opens in
new window BURN OF ESOPHAGUS - BURN OF GASTROINTESTINAL TRACT
959.01 -
959.09 opens in
new window
OTHER AND UNSPECIFIED INJURY TO HEAD - OTHER AND
UNSPECIFIED INJURY TO FACE AND NECK
983.2 -
983.9 opens in
new window
TOXIC EFFECT OF CAUSTIC ALKALIS - TOXIC EFFECT OF
CAUSTIC UNSPECIFIED
990 EFFECTS OF RADIATION UNSPECIFIED
996.82 COMPLICATIONS OF TRANSPLANTED LIVER
997.4 DIGESTIVE SYSTEM COMPLICATIONS NOT ELSEWHERE
CLASSIFIED
E864.1* ACCIDENTAL POISONING BY ACIDS NOT ELSEWHERE
CLASSIFIED
E864.2* ACCIDENTAL POISONING BY CAUSTIC ALKALIS NOT
ELSEWHERE CLASSIFIED
E864.3* ACCIDENTAL POISONING BY OTHER SPECIFIED CORROSIVES
AND CAUSTICS NOT ELSEWHERE CLASSIFIED
E864.4* ACCIDENTAL POISONING BY UNSPECIFIED CORROSIVES AND
CAUSTICS NOT ELSEWHERE CLASSIFIED
E961* ASSAULT BY CORROSIVE OR CAUSTIC SUBSTANCE EXCEPT
POISONING
V10.00 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
UNSPECIFIED SITE IN GASTROINTESTINAL TRACT
V10.03 -
V10.04 opens in
new window
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
ESOPHAGUS - PERSONAL HISTORY OF MALIGNANT NEOPLASM
OF STOMACH
V10.09 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER
SITES IN GASTROINTESTINAL TRACT
V12.71 PERSONAL HISTORY OF PEPTIC ULCER DISEASE
V12.72 PERSONAL HISTORY OF COLONIC POLYPS
V12.79 PERSONAL HISTORY OF OTHER SPECIFIED DIGESTIVE SYSTEM
DISEASES
V18.51 -
V18.59 opens in
new window
FAMILY HISTORY, COLONIC POLYPS - FAMILY HISTORY, OTHER
DIGESTIVE DISORDERS
V55.1 ATTENTION TO GASTROSTOMY
V58.61 LONG-TERM (CURRENT) USE OF ANTICOAGULANTS
V58.64 LONG-TERM (CURRENT) USE OF NONSTEROIDAL ANTIINFLAMMATORIES
V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS
V69.1 INAPPROPRIATE DIET AND EATING HABITS
N/A
XX000 Not Applicable
Diagnoses that DO NOT Support Medical Necessity
N/A
Back
Coding Information for CPT/HCPCS Codes
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
99999 Not Applicable
43235
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
43236
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY
SUBSTANCE
43237
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED
TO THE ESOPHAGUS
43238
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED
INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S),
ESOPHAGUS (INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION
LIMITED TO THE ESOPHAGUS)
43239
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE
43241
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH TRANSENDOSCOPIC INTRALUMINAL TUBE OR
CATHETER PLACEMENT
43243
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL AND/OR
GASTRIC VARICES
43244
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BAND LIGATION OF ESOPHAGEAL AND/OR GASTRIC
VARICES
43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR OBSTRUCTION
(EG, BALLOON, GUIDE WIRE, BOUGIE)
43246
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCUTANEOUS
GASTROSTOMY TUBE
43247
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF FOREIGN BODY
43248
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION
OF ESOPHAGUS OVER GUIDE WIRE
43249
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30
MM DIAMETER)
43250
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
43251
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) BY SNARE TECHNIQUE
43255
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH CONTROL OF BLEEDING, ANY METHOD
43258
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,
STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER
LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS,
BIPOLAR CAUTERY OR SNARE TECHNIQUE
ICD-9 Codes that Support Medical Necessity
040.2 WHIPPLE'S DISEASE
112.84 CANDIDAL ESOPHAGITIS
150.0 -
152.9 opens in
new window
MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS -
MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED
SITE
155.0 MALIGNANT NEOPLASM OF LIVER PRIMARY
156.0 -
156.9 opens in
new window
MALIGNANT NEOPLASM OF GALLBLADDER - MALIGNANT
NEOPLASM OF BILIARY TRACT PART UNSPECIFIED SITE
157.0 -
157.9 opens in new window
MALIGNANT NEOPLASM OF HEAD OF PANCREAS - MALIGNANT
NEOPLASM OF PANCREAS PART UNSPECIFIED
159.8 MALIGNANT NEOPLASM OF OTHER SITES OF DIGESTIVE
SYSTEM AND INTRA-ABDOMINAL ORGANS
176.3 KAPOSI'S SARCOMA GASTROINTESTINAL SITES
197.4 SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE
INCLUDING DUODENUM
197.6 SECONDARY MALIGNANT NEOPLASM OF RETROPERITONEUM
AND PERITONEUM
198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED
SITES
202.80 OTHER MALIGNANT LYMPHOMAS UNSPECIFIED SITE
211.0 -
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BENIGN NEOPLASM OF ESOPHAGUS - BENIGN NEOPLASM OF
OTHER AND UNSPECIFIED SITE IN THE DIGESTIVE SYSTEM
214.3 LIPOMA OF INTRA-ABDOMINAL ORGANS
214.9 LIPOMA UNSPECIFIED SITE
215.9 OTHER BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT
TISSUE SITE UNSPECIFIED
228.04 HEMANGIOMA OF INTRA-ABDOMINAL STRUCTURES
230.1 -
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CARCINOMA IN SITU OF ESOPHAGUS - CARCINOMA IN SITU OF
LIVER AND BILIARY SYSTEM
235.2 -
235.4 opens in
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NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH
INTESTINES AND RECTUM - NEOPLASM OF UNCERTAIN
BEHAVIOR OF RETROPERITONEUM AND PERITONEUM
239.0 NEOPLASM OF UNSPECIFIED NATURE OF DIGESTIVE SYSTEM
251.5 ABNORMALITY OF SECRETION OF GASTRIN
261 NUTRITIONAL MARASMUS
263.0 -
263.9 opens in
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MALNUTRITION OF MODERATE DEGREE - UNSPECIFIED
PROTEIN-CALORIE MALNUTRITION
280.0 -
280.9 opens in
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IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS
(CHRONIC) - IRON DEFICIENCY ANEMIA UNSPECIFIED
285.1 ACUTE POSTHEMORRHAGIC ANEMIA
300.11 CONVERSION DISORDER
306.4 GASTROINTESTINAL MALFUNCTION ARISING FROM MENTAL
FACTORS
307.1 ANOREXIA NERVOSA
307.50 EATING DISORDER UNSPECIFIED
307.51 BULIMIA NERVOSA
307.52 PICA
307.53 RUMINATION DISORDER
307.54 PSYCHOGENIC VOMITING
438.82 DYSPHAGIA CEREBROVASCULAR DISEASE
447.2 RUPTURE OF ARTERY
448.0 HEREDITARY HEMORRHAGIC TELANGIECTASIA
456.0 ESOPHAGEAL VARICES WITH BLEEDING
456.1 ESOPHAGEAL VARICES WITHOUT BLEEDING
456.20 -
456.21 opens in
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ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE
WITH BLEEDING - ESOPHAGEAL VARICES IN DISEASES
CLASSIFIED ELSEWHERE WITHOUT BLEEDING
507.0 PNEUMONITIS DUE TO INHALATION OF FOOD OR VOMITUS
530.0 -
530.89 opens in
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ACHALASIA AND CARDIOSPASM - OTHER DISEASES OF
ESOPHAGUS
531.00 -
531.91 opens in
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ACUTE GASTRIC ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - GASTRIC ULCER UNSPECIFIED AS ACUTE OR
CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
532.00 -
532.91 opens in
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ACUTE DUODENAL ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - DUODENAL ULCER UNSPECIFIED AS ACUTE OR
CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
533.00 -
533.91 opens in
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ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH
HEMORRHAGE WITHOUT OBSTRUCTION - PEPTIC ULCER OF
UNSPECIFIED SITE UNSPECIFIED AS ACUTE OR CHRONIC
WITHOUT HEMORRHAGE OR PERFORATION WITH
OBSTRUCTION
534.00 -
534.91 opens in
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ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE WITHOUT
OBSTRUCTION - GASTROJEJUNAL ULCER UNSPECIFIED AS
ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR
PERFORATION WITH OBSTRUCTION
535.00 -
535.71 opens in
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ACUTE GASTRITIS (WITHOUT HEMORRHAGE) - EOSINOPHILIC
GASTRITIS, WITH HEMORRHAGE
536.1 ACUTE DILATATION OF STOMACH
536.2 PERSISTENT VOMITING
536.3 GASTROPARESIS
536.40 -
536.49 opens in
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GASTROSTOMY COMPLICATION UNSPECIFIED - OTHER
GASTROSTOMY COMPLICATIONS
536.8 DYSPEPSIA AND OTHER SPECIFIED DISORDERS OF FUNCTION
OF STOMACH
537.0 -
537.89 opens in
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ACQUIRED HYPERTROPHIC PYLORIC STENOSIS - OTHER
SPECIFIED DISORDERS OF STOMACH AND DUODENUM
538 GASTROINTESTINAL MUCOSITIS (ULCERATIVE)
551.3 DIAPHRAGMATIC HERNIA WITH GANGRENE
552.3 -
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DIAPHRAGMATIC HERNIA WITH OBSTRUCTION - HERNIA OF
OTHER SPECIFIED SITES WITH OBSTRUCTION
553.3 DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR
GANGRENE
555.0 -
555.9 opens in
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REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL
ENTERITIS OF UNSPECIFIED SITE
560.9 UNSPECIFIED INTESTINAL OBSTRUCTION
562.01 DIVERTICULITIS OF SMALL INTESTINE (WITHOUT
HEMORRHAGE)
562.02 DIVERTICULOSIS OF SMALL INTESTINE WITH HEMORRHAGE
562.03 DIVERTICULITIS OF SMALL INTESTINE WITH HEMORRHAGE
569.62 MECHANICAL COMPLICATION OF COLOSTOMY AND
ENTEROSTOMY
569.71 -
569.79 opens in
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POUCHITIS - OTHER COMPLICATIONS OF INTESTINAL POUCH
569.82 ULCERATION OF INTESTINE
569.87 VOMITING OF FECAL MATTER
571.1 ACUTE ALCOHOLIC HEPATITIS
571.2 ALCOHOLIC CIRRHOSIS OF LIVER
571.3 ALCOHOLIC LIVER DAMAGE UNSPECIFIED
571.40 CHRONIC HEPATITIS UNSPECIFIED
571.41 CHRONIC PERSISTENT HEPATITIS
571.42 AUTOIMMUNE HEPATITIS
571.49 OTHER CHRONIC HEPATITIS
571.5 CIRRHOSIS OF LIVER WITHOUT ALCOHOL
571.6 BILIARY CIRRHOSIS
572.3 PORTAL HYPERTENSION
574.00 -
574.01 opens in
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CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER WITH
ACUTE CHOLECYSTITIS WITH OBSTRUCTION
574.10 -
574.11 opens in
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CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER WITH
OTHER CHOLECYSTITIS WITH OBSTRUCTION
574.20 -
574.21 opens in
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CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF GALLBLADDER
WITHOUT CHOLECYSTITIS WITH OBSTRUCTION
574.30 -
574.31 opens in
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CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF BILE DUCT WITH
ACUTE CHOLECYSTITIS WITH OBSTRUCTION
574.40 -
574.41 opens in
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CALCULUS OF BILE DUCT WITH OTHER CHOLECYSTITIS
WITHOUT OBSTRUCTION - CALCULUS OF BILE DUCT WITH
OTHER CHOLECYSTITIS WITH OBSTRUCTION
575.0 ACUTE CHOLECYSTITIS
575.5 FISTULA OF GALLBLADDER
576.0 POSTCHOLECYSTECTOMY SYNDROME
576.4 FISTULA OF BILE DUCT
577.0 ACUTE PANCREATITIS
577.1 CHRONIC PANCREATITIS
577.2 CYST AND PSEUDOCYST OF PANCREAS
578.0 -
578.9 opens in
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HEMATEMESIS - HEMORRHAGE OF GASTROINTESTINAL TRACT
UNSPECIFIED
579.0 -
579.9 opens in
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CELIAC DISEASE - UNSPECIFIED INTESTINAL MALABSORPTION
694.0 DERMATITIS HERPETIFORMIS
710.1 SYSTEMIC SCLEROSIS
747.61 GASTROINTESTINAL VESSEL ANOMALY
750.3 CONGENITAL TRACHEOESOPHAGEAL FISTULA ESOPHAGEAL
ATRESIA AND STENOSIS
750.4 OTHER SPECIFIED CONGENITAL ANOMALIES OF ESOPHAGUS
750.5 CONGENITAL HYPERTROPHIC PYLORIC STENOSIS
750.6 CONGENITAL HIATUS HERNIA
750.7 OTHER SPECIFIED CONGENITAL ANOMALIES OF STOMACH
783.0 ANOREXIA
783.21 -
783.3 opens in
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LOSS OF WEIGHT - FEEDING DIFFICULTIES AND
MISMANAGEMENT
784.42 DYSPHONIA
784.43 HYPERNASALITY
784.44 HYPONASALITY
784.49 OTHER VOICE AND RESONANCE DISORDERS
784.52 FLUENCY DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE
784.91 -
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POSTNASAL DRIP - OTHER SYMPTOMS INVOLVING HEAD AND
NECK
786.2 COUGH
786.50 -
786.59 opens in
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UNSPECIFIED CHEST PAIN - OTHER CHEST PAIN
786.6 SWELLING MASS OR LUMP IN CHEST
787.01 -
787.91 opens in
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NAUSEA WITH VOMITING - DIARRHEA
789.00 -
789.09 opens in
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ABDOMINAL PAIN UNSPECIFIED SITE - ABDOMINAL PAIN OTHER
SPECIFIED SITE
789.30 -
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ABDOMINAL OR PELVIC SWELLING MASS OR LUMP
UNSPECIFIED SITE - ABDOMINAL OR PELVIC SWELLING MASS
OR LUMP OTHER SPECIFIED SITE
789.51 -
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MALIGNANT ASCITES - OTHER ASCITES
789.60 -
789.69 opens in
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ABDOMINAL TENDERNESS UNSPECIFIED SITE - ABDOMINAL
TENDERNESS OTHER SPECIFIED SITE
790.5 OTHER NONSPECIFIC ABNORMAL SERUM ENZYME LEVELS
790.99 OTHER ABNORMAL FINDINGS ON EXAMINATION OF BLOOD
792.1 NONSPECIFIC ABNORMAL FINDINGS IN STOOL CONTENTS
793.4 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND
OTHER EXAMINATION OF GASTROINTESTINAL TRACT
793.6
NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND
OTHER EXAMINATION OF ABDOMINAL AREA, INCLUDING
RETROPERITONEUM
799.4 CACHEXIA
862.22 INJURY TO ESOPHAGUS WITHOUT OPEN WOUND INTO CAVITY
874.4 -
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OPEN WOUND OF PHARYNX WITHOUT COMPLICATION - OPEN
WOUND OF PHARYNX COMPLICATED
935.1 -
935.2 opens in
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FOREIGN BODY IN ESOPHAGUS - FOREIGN BODY IN STOMACH
936 FOREIGN BODY IN INTESTINE AND COLON
938 FOREIGN BODY IN DIGESTIVE SYSTEM UNSPECIFIED
947.0 BURN OF MOUTH AND PHARYNX
947.2 -
Diagnoses that Support Medical Necessity
N/A
ICD-9 Codes that DO NOT Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
* According to the ICD-9-CM book, diagnosis codes E864.1, E864.2, E864.3, E864.4 and E961 are secondary diagnosis codes and should not be billed as the primary diagnosis.
947.3 opens in
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959.01 -
959.09 opens in
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OTHER AND UNSPECIFIED INJURY TO HEAD - OTHER AND
UNSPECIFIED INJURY TO FACE AND NECK
983.2 -
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TOXIC EFFECT OF CAUSTIC ALKALIS - TOXIC EFFECT OF
CAUSTIC UNSPECIFIED
990 EFFECTS OF RADIATION UNSPECIFIED
996.82 COMPLICATIONS OF TRANSPLANTED LIVER
997.4 DIGESTIVE SYSTEM COMPLICATIONS NOT ELSEWHERE
CLASSIFIED
E864.1* ACCIDENTAL POISONING BY ACIDS NOT ELSEWHERE
CLASSIFIED
E864.2* ACCIDENTAL POISONING BY CAUSTIC ALKALIS NOT
ELSEWHERE CLASSIFIED
E864.3* ACCIDENTAL POISONING BY OTHER SPECIFIED CORROSIVES
AND CAUSTICS NOT ELSEWHERE CLASSIFIED
E864.4* ACCIDENTAL POISONING BY UNSPECIFIED CORROSIVES AND
CAUSTICS NOT ELSEWHERE CLASSIFIED
E961* ASSAULT BY CORROSIVE OR CAUSTIC SUBSTANCE EXCEPT
POISONING
V10.00 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
UNSPECIFIED SITE IN GASTROINTESTINAL TRACT
V10.03 -
V10.04 opens in
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PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
ESOPHAGUS - PERSONAL HISTORY OF MALIGNANT NEOPLASM
OF STOMACH
V10.09 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER
SITES IN GASTROINTESTINAL TRACT
V12.71 PERSONAL HISTORY OF PEPTIC ULCER DISEASE
V12.72 PERSONAL HISTORY OF COLONIC POLYPS
V12.79 PERSONAL HISTORY OF OTHER SPECIFIED DIGESTIVE SYSTEM
DISEASES
V18.51 -
V18.59 opens in
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FAMILY HISTORY, COLONIC POLYPS - FAMILY HISTORY, OTHER
DIGESTIVE DISORDERS
V55.1 ATTENTION TO GASTROSTOMY
V58.61 LONG-TERM (CURRENT) USE OF ANTICOAGULANTS
V58.64 LONG-TERM (CURRENT) USE OF NONSTEROIDAL ANTIINFLAMMATORIES
V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS
V69.1 INAPPROPRIATE DIET AND EATING HABITS
N/A
XX000 Not Applicable
Diagnoses that DO NOT Support Medical Necessity
N/A
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