Accurate billing, reimbursement, and compliance with upper gastrointestinal procedures depend on selecting the correct codes—especially when determining the appropriate CPT code for EGD with biopsy, the CPT code for EGD without biopsy, or understanding specific codes such as the 43235 CPT code and the 43239 CPT code description. Coding for an esophagogastroduodenoscopy (EGD) requires precise use of procedure codes (CPT), including more specialized options like the CPT code for EGD with dilation or combination services that involve both endoscopy and colonoscopy, which fall under the CPT code for endoscopy and colonoscopy and the colonoscopy CPT code. This guide from A2Z Billings explains how to use EGD CPT codes correctly, what to look for, and how to prevent denials. We also cover related codes often searched by billing professionals, such as the CPT code for laparoscopic appendectomy and the 43237 CPT code description.
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.
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)
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.
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.
FAQs
1. What is the CPT code for EGD procedure?
The most commonly used CPT code for EGD is 43235, which represents a diagnostic Esophagogastroduodenoscopy. This code applies when the physician performs a visual examination only – without biopsy, dilation, stent placement, or polyp removal.
2. What is the CPT code for EGD with biopsy?
The CPT code for EGD with biopsy is 43239. It is used when the physician performs an upper GI endoscopy and collects tissue samples for pathology, either from the esophagus, stomach, or duodenum.
3. What is the CPT code for EGD with dilation?
Use CPT 43249 when balloon dilation of the esophagus or pylorus is performed during endoscopy. This is usually reported for patients with strictures, swallowing issues, or stenosis.
4. What is the CPT code for EGD with polyp removal?
Use CPT 43251 when a snare technique is used to remove polyps, tumors, or lesions during the EGD. It is a therapeutic code and reimburses higher than diagnostic-only scopes.
5. Which CPT code is used for EGD with control of bleeding?
The correct code for EGD with hemostasis/bleeding control is 43255. It applies when cautery, clipping, injection, or other methods are used to stop active bleeding during the procedure.
6. Can multiple EGD CPT codes be billed together?
In most cases, only one primary EGD CPT code is billed per session.
However, if multiple therapeutic procedures are performed, modifiers may be required. Always check payer-specific guidelines to avoid bundling denials.