CPT Code for EGD – What Medical Billers Need to Know

In addition to EGD categories—diagnostic vs. therapeutic, biopsy, polyp removal, or stent placement—we highlight common billing errors to help billers, coders, and healthcare providers achieve accurate, compliant claims.

What Is EGD? Why Does It Matter?

During an upper GI endoscopy (EGD), the doctor puts a flexible tube through your mouth to check out the lining of your food pipe, stomach, and the first part of your small intestine. Doctors use this EGD to find out what’s wrong or fix problems in your upper digestive system, like heartburn, ulcers, bleeding, swelling, tumors, polyps, narrow spots, or things that shouldn’t be there. The price code for an EGD changes based on what the doctor does during the process. It might be just for looking around, or they might take a sample, remove a polyp, widen a narrow spot, put in a stent, stop bleeding, or take something out. Knowing the right codes is key.

What Is the CPT Code for EGD? (General Endoscopy Code Guide)

Many billers and providers search for “what is the CPT code for EGD” or “EGD procedure code” when documenting upper endoscopy services. The most commonly reported esophagogastroduodenoscopy CPT code is 43235, which represents a diagnostic upper GI endoscopy performed without biopsy or therapeutic intervention. This code may also be referred to as the upper endoscopy CPT code, upper GI endoscopy CPT code, or gastroscopy CPT code, as all describe the same transoral endoscopic evaluation of the esophagus, stomach, and duodenum. When no biopsy, dilation, stent placement, or bleeding control is performed, 43235 remains the appropriate diagnostic EGD CPT code. Understanding the full CPT codes for endoscopy ensures accurate reporting and prevents bundling errors.

Common CPT Codes for EGD Procedures

Below is a breakdown of frequently used CPT codes for EGD procedures – from simple diagnostic scopes to therapeutic endoscopies.

CPT Code	Description / When to Use
43235	Diagnostic EGD (flexible, transoral), including specimen collection via brushing or washing, if performed. Use when the procedure is a simple visual examination of the esophagus, stomach, and duodenum – no biopsy or therapeutic intervention.
43239	EGD with biopsy (single or multiple). Use when, during the endoscopy, tissue samples are taken for pathology (e.g. suspicious lesions, ulcers, inflammation, tumors).
43236	EGD with directed submucosal injection(s) (e.g. injection therapy) – when injections are administered during the EGD.
43237	EGD with endoscopic ultrasound examination (limited to esophagus, stomach, duodenum) – when EUS is performed along with EGD.
43238	EGD with transendoscopic ultrasound–guided biopsy or aspiration (i.e. EUS-guided tissue sampling) – when more advanced diagnostic sampling is done.
43241	EGD with insertion of intraluminal tube or catheter – used when, during EGD, a tube or catheter is placed (e.g. for feeding, drainage).
43247	EGD with removal of foreign body(s) – when EGD is used to remove objects from esophagus/stomach/duodenum.
43249	EGD with transendoscopic balloon dilation of esophagus (for strictures) – when dilation is done via balloon during EGD.
43251	EGD with removal of polyp(s), tumor(s), or other lesion(s) by snare technique – when polypectomy or lesion removal is performed.
43255	EGD with control of bleeding (any method: cautery, clips, etc.) – when bleeding is treated during the EGD procedure.
43266	EGD with placement of endoscopic stent (includes pre- and post-dilation and guide wire, if performed) – used when stent placement is done to treat strictures or other obstructions.
43270	EGD with removal of foreign body (some sources list as removal/foreign body retrieval) – depending on payer guidelines.

  Note: The range of EGD CPT codes falls roughly between 43235 and 43270, covering diagnostic, therapeutic, and interventional upper GI procedures.

Diagnostic vs. Therapeutic EGD: Why the Distinction Matters

When coding an EGD, the most important thing to know is if it was just for looking around (diagnostic) or if something was done during it (therapeutic/interventional), like taking a biopsy or removing a polyp.

• Diagnostic EGD** (like CPT code 43235): This is when the doctor uses the scope to check for things like problems, swelling, sores, bleeding, or growths. No tissue is taken, and nothing is removed or placed. It’s usually easier to document and doesn’t pay as much.
• Therapeutic/Interventional EGD** (like CPT codes 43239, 43251, 43249, 43255): This is when the doctor does extra stuff, like taking tissue samples, removing polyps, stretching things out, putting in a stent, stopping bleeding, or pulling out a foreign object. You’ll need to write down more details about what was done, how it was done, and why. These usually pay more because they’re more involved and use more resources.

For medical billing and coding professionals (like A2Z Billings), distinguishing diagnostic from therapeutic EGD — and selecting the accurate CPT code — is vital to avoid claim denials, underpayment, or audits.

Common Scenarios & Which CPT Code to Use

Here are typical clinical scenarios with guidance on which CPT code to use.

Scenario 1: Patient has acid reflux / GERD / dyspepsia; physician performs scope to inspect mucosa — no biopsy, no intervention

→ Use CPT 43235 (Diagnostic EGD)

Scenario 2: During scope, physician sees suspicious lesion and takes tissue samples for pathology

→ Use CPT 43239 (EGD with biopsy)

Scenario 3: Polyp or small lesion found and removed via snare during EGD

→ Use CPT 43251 (EGD with polyp / lesion removal by snare)

Scenario 4: Esophageal stricture identified, balloon dilation performed during EGD

→ Use CPT 43249 (EGD with transendoscopic balloon dilation)

Scenario 5: Patient swallowed a foreign object; EGD used to retrieve object

→ Use CPT 43247 (EGD with foreign body removal) or CPT 43270 depending on payer definitions

Scenario 6: Bleeding ulcer or varix seen; endoscopic therapy applied to control bleeding (e.g. clipping, cautery)

→ Use CPT 43255 (EGD with control of bleeding)

Scenario 7: During EGD, endoscopist places a stent because of stricture or obstruction

→ Use CPT 43266 (EGD with stent placement)

Scenario 8: EGD with insertion of a feeding tube or intraluminal catheter

→ Use CPT 43241 (EGD with intraluminal tube/catheter insertion)

Advanced Therapeutic EGD Codes: EMR, Ablation, Stents & Injections

Beyond standard biopsy and dilation, advanced therapeutic EGDs require careful CPT selection. For example, EGD with stent placement CPT code 43266 is used when an endoscopic stent is inserted to treat obstruction, while stent removal may require separate reporting depending on payer policy. Procedures such as EGD with injection CPT code 43236 apply when directed submucosal injections are performed, including cases involving botulinum toxin (Botox). When bleeding is treated using argon plasma coagulation (APC) or other cautery methods, coders typically report 43255 (EGD with control of bleeding CPT code). More advanced resections such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) must be coded according to lesion removal technique and documentation specifics. Because these procedures fall within the broader endoscopic stomal procedures range (43235–43999), precise documentation is essential to avoid payer denials and underpayment.

Why Accurate Documentation and Coding Matter

Selecting the appropriate CPT code is not merely a matter of choice; it has an impact on reimbursement, compliance, audits performed by payers and revenue cycle management.

• As payers will typically audit claims for upper gastrointestinal endoscopy (EGD), they are particularly likely to do so for claims that include therapy (biopsy, polypectomy, dilation and stenting) since they typically involve higher risk and higher costs.
• When the documentation is unclear as to what was performed, such as differentiation between biopsy and simple diagnostic scope; Therapeutic Intervention; instrument used, these claims will be denied or underpaid if appropriate documentation is not provided.
• The application of bundling edits or payer specific billing edits have a direct effect on multiple procedures performed on any one EGD and how the individual procedures shall be billed, should they be able to be billed separately, or must they be bundled up, including the improper coding resulting in a denial.
• When coding for follow up EGDs, as in the case of polyposis removal or stricture dilation or stent placement, it is necessary for the coder to code the appropriate Therapeutic CPT Codes and consider global periods for modifiers and documentation of previous intervention(s).

At A2Z Billings, we place a premium on ensuring that EGD procedures are coded properly to help ensure that you are appropriately paid and minimize the potential for denials and audits.  

ICD-10, Medicare Coverage & EGD Billing Considerations

While CPT codes describe the procedure, an ICD-10 code for EGD must justify medical necessity. There is no standalone “EGD ICD-10” code; instead, diagnosis codes such as GERD, dysphagia, GI bleeding, ulcers, or suspected malignancy support the claim. Medicare and commercial payers evaluate whether the documented indication meets coverage criteria, making the question “does Medicare cover EGD?” dependent on diagnosis and clinical necessity. Additionally, billers frequently ask about the EGD global period — most diagnostic EGDs have a 0-day global period, meaning follow-up visits are separately billable unless related to complications. Understanding the difference between CPT 43235 (diagnostic) and CPT 43239 (with biopsy) is also crucial, as 43239 includes the scope and tissue sampling and should not be billed with 43235. Proper alignment of CPT selection, ICD-10 support, and payer rules ensures audit protection and optimized reimbursement.  

Tips for Billers & Coders: Best Practices for EGD Coding

To optimize EGD coding and reimbursement, follow these best practices:

Review procedure documentation in detail 

Review documentation to ensure that you understand all of the documentation done in an endoscopy. Was it diagnostic only? Did you take any biopsies? Did you remove polyps? Did you place stents? Did you control bleeding? Did you remove foreign bodies? Did you dilate? For each service performed, you should select the highest level service from among the services rendered.

Use one CPT code per EGD session as primary code 

When two or more procedures are performed on a patient during one EGD session, you have to report only one primary CPT code; the other services may require modifiers or billable as separate services.  

Ensure documentation supports medical necessity and intervention details 

Therapeutic procedures require documentation of the indication for the procedure, including all instruments used (snare, forceps, biopsy forceps, balloon, stent), the anatomical site, and any complications associated with the procedure or adjunctive procedures that may have been performed.

Stay updated with payer-specific guidelines and bundling edits 

Some payers may interpret certain combinations differently; always cross-check with the payer’s current billing rules, especially for complex EGD (dilation, stent, stent + dilation, biopsy + therapy, etc.).

Coordinate with clinical staff to ensure accurate endoscopy reports 

You will need to work with your clinical staff to ensure that their endoscopy reports match what has been billed to the payer. Ensure that clinical endoscopy and pathology reports (if biopsies were taken) are properly linked to support billing for audits and reimbursements.

Use accurate diagnosis codes (ICD-10) that justify the EGD procedure 

Ensure the indication for EGD (GERD, ulcers, bleeding, dysphagia, polyp follow-up, etc.) is documented and coded correctly to support medical necessity.

Common Mistakes & Pitfalls – and How to Avoid Them

Even experienced coders and billers make errors when coding EGD. Here are frequent mistakes and how to avoid them:

• Coding 43235 when a biopsy was done – or vice versa: Always verify whether tissue samples were taken. If biopsy, code 43239; if purely diagnostic, code 43235.
• Billing multiple EGD codes for a single procedure session: Some may attempt to bill both 43235 (diagnostic) and 43239 (biopsy) – this is incorrect, as 43239 already includes the scope + biopsy. Use one code per session per payer rules.
• Insufficient documentation for therapeutic interventions: If polyp removal, stent placement, bleeding control, or dilation was done, but the endoscopy report lacks details (site, method, instruments), payers may deny or downcode.
• Not using correct modifiers when required: If multiple procedures are legitimately separate (e.g. EGD + foreign body removal, or EGD + dilation + stent), check payer rules and apply modifiers (e.g. distinct procedural Service, modifier 59) as needed.
• Ignoring payer-specific bundling rules / edits: Some payers may bundle certain services or disallow multiple billable procedures within one session. Always verify against the payer’s policy.
• Omitting ICD-10 diagnosis codes or failing to justify medical necessity: EGD must be medically necessary – simply performing scope without documented indication (e.g. GERD, bleeding, pain, tumor workup) may lead to denial.

At A2Z Billings, we help clients avoid these pitfalls – ensuring clean claims, appropriate documentation, and optimized reimbursement.

Why This Matters for Medical Billing Services & Revenue Cycle Management

As a medical billing service provider, knowing the correct CPT codes for EGD – and using them properly – offers multiple benefits:

• Accurate claims submission & fewer denials: Proper coding, backed by documentation, reduces claim denials, rejections, or payer audits.
• Maximized reimbursement for providers: Therapeutic and interventional EGDs (biopsy, polyp removal, stent, dilation, etc.) are higher complexity – coding them correctly ensures providers receive fair compensation.
• Compliance & audit readiness: Clear documentation + correct CPT selection + compliance with payer rules helps protect providers and billing services from audits, investigations, or paybacks.
• Efficient billing workflows: A standardized, well-documented coding framework allows billers to work faster and with greater accuracy — saving time and reducing billing overhead.

For a company like A2Z Billings that offers medical billing and coding services, mastery of CPT coding (including EGD) is essential to deliver high-quality, reliable service to GI clinics, gastroenterologists, and hospitals.

Summary & Conclusion

Upper gastrointestinal endoscopy (EGD) is used for both diagnoses and treatments, such as biopsies, removal of polyps, dilating a stricture in the food pipe, inserting a stent, controlling bleeding, and removing a foreign body. CPT Codes for EGD procedures range from 43235 to 43270. The code assigned to an EGD procedure is based on what services were provided. The most commonly used codes for EGD procedures include 43235 for a standard diagnostic EGD and 43239 for an EGD with a biopsy. These two codes are used for EGD procedures performed without any advanced procedures (dilation, insertion of stents, and the like). All additional advanced EGD procedures will have their own individual CPT Codes assigned to them. Billers and medical billing companies, such as A2Z Billings, are required to accurately code EGD procedures to ensure compliance with billing requirements and to facilitate appropriate reimbursement and reduce lost opportunities for reimbursement on denied claims and improve the overall efficiency of the revenue cycle for their clients.