LCD/NCD Portal

L29167

 

DIAGNOSTIC AND THERAPEUTIC ESOPHAGOGASTRODUODENOSCOPY

 

10/01/2011

 

Indications and Limitations of Coverage and/or Medical Necessity

Medicare will consider EGD(s) to be medically reasonable and necessary under the following diagnostic conditions:

• Patient has upper abdominal distress (e.g., gastroesophageal reflux disease) which persists despite an appropriate trial of symptomatic therapy.

• Patient has upper abdominal distress associated with a short history of signs and symptoms suggesting significant associated disease or illness e.g.:

o Weight loss.

o Anorexia.

o Vomiting.

o Nonsteroidal anti-inflammatory drug NSAID intake.

o Other gastric irritant intake.

• Patients over the age of 40 who have experienced a significant history of heartburn that returns after a course of symptomatic therapy.

• Patients who have dysphagia or odynophagia.

• Patient has persistent, unexplained vomiting.

• Patient has upper gastrointestinal x-ray findings of:

o Any lesion that requires biopsy for diagnosis.

o Gastric ulcer suspicious of cancer.

o Evidence of stricture or obstruction.

• To assess acute injury after caustic agent ingestion;

• When anti-reflux surgery is contemplated.

• Patient has gastrointestinal bleeding:

o In most actively bleeding patients.

o For presumed chronic blood loss and iron deficiency anemia when investigation of large bowel is negative.

 

Medicare will consider EGD(s) to be medically reasonable and necessary for the following therapeutic purposes:

• Treatment of bleeding lesions.

• Removal of foreign bodies.

• Sclerotherapy and/or band ligation for bleeding from esophageal or gastric varices.

• Dilatation of strictures in the upper intestinal tract.

• Removal of selected polypoid lesions.

• Placement of feeding tubes.

• Palliative therapy of stenosing neoplasms (e.g., laser, stent placement).

• Gastrointestinal bleeding may be treated with a variety of methods.

o Direct contact heater probes and hemostatic injections into or around the bleeding vessels are both effective therapy for acute bleeding.

• Foreign body removal from the stomach or esophagus is usually successful with these flexible instruments.

o The foreign bodies can be retrieved by either of two methods.

o The first method is to capture the foreign body with a snare device/grasping forceps and pull the item out with the endoscope.

o The second method is accomplished by piecemeal destruction and pushing the bolus through the esophagus into the stomach.

• Esophageal varices may be injected with a variety of sclerosing solutions.

o Eradication of varices requires, on the average, five sclerotherapy sessions, with multiple injections given during each session.

• Dilatation of strictures may be accomplished with a balloon placed through the endoscope and inflated using hydrostatic pressure.

o Bougies are rubber dilators available in various sizes up to approximately 2.0cm.

o Plastic bougies and other dilating probes are usually passed over a guide wire.

o This procedure involves placing the guide wire into the stomach through the endoscope.

o The endoscope is then withdrawn leaving the guide wire in place.

o The dilating probes and plastic bougies are then passed over the guide wire.

o After the largest dilator is used, the dilator and guide wire are removed.

o Esophageal dilation is performed after a definitive diagnosis has been established in patients exhibiting dysphagia.

o The goal in most cases is a lumenal diameter of 16-17mm which allows passage of solid food.

o A series of dilators may be passed over the guide wire to reach the goal of therapy.

Medicare will consider follow-up EGD(s) medically reasonable and necessary for the following indications:

• Biopsy surveillance of patients with Barrett’s esophagus every 12 to 24 months.

o However, if dysplasia is present, earlier surveillance intervals of from three to six months may be required.

• Follow-up of gastric ulcers to healing or satisfaction that they are benign.

• Follow-up and treatment of esophageal strictures requiring guidewire dilation.

• Follow-up of duodenal ulcer or other lesions of the upper gastrointestinal tract that have resulted in serious consequences (e.g., hemorrhage).

• Follow-up of patients having a previous gastric polypectomy for adenoma.

• Follow-up and treatment of patients with esophageal varices or bleeding lesions requiring recurrent therapy:

o Esophageal varices.

o Gastric varices.

o Angiodysplastic or watermelon stomach lesions.

o Radiation gastritis.

• Follow-up for removal of percutaneous gastrostomy tube (PEG)

 

• Periodic EGD is NOT usually indicated in the following situations:

o Surveillance of healed, benign disease such as gastric or duodenal ulcer or benign esophageal strictures.

o Cancer surveillance in patients with pernicious anemia, treated achalasia, or prior gastric resection.

• EGD is generally contraindicated for patients with recent myocardial infarction.

 

 

CPT/HCPCS Codes

 

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 MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS

150.1 MALIGNANT NEOPLASM OF THORACIC ESOPHAGUS

150.2 MALIGNANT NEOPLASM OF ABDOMINAL ESOPHAGUS

150.3 MALIGNANT NEOPLASM OF UPPER THIRD OF ESOPHAGUS

150.4 MALIGNANT NEOPLASM OF MIDDLE THIRD OF ESOPHAGUS

150.5 MALIGNANT NEOPLASM OF LOWER THIRD OF ESOPHAGUS

150.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED PART OF ESOPHAGUS

150.9 MALIGNANT NEOPLASM OF ESOPHAGUS UNSPECIFIED SITE

151.0 MALIGNANT NEOPLASM OF CARDIA

151.1 MALIGNANT NEOPLASM OF PYLORUS

151.2 MALIGNANT NEOPLASM OF PYLORIC ANTRUM

151.3 MALIGNANT NEOPLASM OF FUNDUS OF STOMACH

151.4 MALIGNANT NEOPLASM OF BODY OF STOMACH

151.5 MALIGNANT NEOPLASM OF LESSER CURVATURE OF STOMACH UNSPECIFIED

151.6 MALIGNANT NEOPLASM OF GREATER CURVATURE OF STOMACH UNSPECIFIED

151.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF STOMACH

151.9 MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE

152.0 MALIGNANT NEOPLASM OF DUODENUM

152.1 MALIGNANT NEOPLASM OF JEJUNUM

152.2 MALIGNANT NEOPLASM OF ILEUM

152.3 MALIGNANT NEOPLASM OF MECKEL'S DIVERTICULUM

152.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SMALL INTESTINE

152.9 MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED SITE

155.0 MALIGNANT NEOPLASM OF LIVER PRIMARY

156.0 MALIGNANT NEOPLASM OF GALLBLADDER

156.1 MALIGNANT NEOPLASM OF EXTRAHEPATIC BILE DUCTS

156.2 MALIGNANT NEOPLASM OF AMPULLA OF VATER

156.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF GALLBLADDER AND EXTRAHEPATIC BILE DUCTS

156.9 MALIGNANT NEOPLASM OF BILIARY TRACT PART UNSPECIFIED SITE

157.0 MALIGNANT NEOPLASM OF HEAD OF PANCREAS

157.1 MALIGNANT NEOPLASM OF BODY OF PANCREAS

157.2 MALIGNANT NEOPLASM OF TAIL OF PANCREAS

157.3 MALIGNANT NEOPLASM OF PANCREATIC DUCT

157.4 MALIGNANT NEOPLASM OF ISLETS OF LANGERHANS

157.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF PANCREAS

157.9 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 BENIGN NEOPLASM OF ESOPHAGUS

211.1 BENIGN NEOPLASM OF STOMACH

211.2 BENIGN NEOPLASM OF DUODENUM JEJUNUM AND ILEUM

211.3 BENIGN NEOPLASM OF COLON

211.4 BENIGN NEOPLASM OF RECTUM AND ANAL CANAL

211.5 BENIGN NEOPLASM OF LIVER AND BILIARY PASSAGES

211.6 BENIGN NEOPLASM OF PANCREAS EXCEPT ISLETS OF LANGERHANS

211.7 BENIGN NEOPLASM OF ISLETS OF LANGERHANS

211.8 BENIGN NEOPLASM OF RETROPERITONEUM AND PERITONEUM

211.9 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 CARCINOMA IN SITU OF ESOPHAGUS

230.2 CARCINOMA IN SITU OF STOMACH

230.3 CARCINOMA IN SITU OF COLON

230.4 CARCINOMA IN SITU OF RECTUM

230.5 CARCINOMA IN SITU OF ANAL CANAL

230.6 CARCINOMA IN SITU OF ANUS UNSPECIFIED

230.7 CARCINOMA IN SITU OF OTHER AND UNSPECIFIED PARTS OF INTESTINE

230.8 CARCINOMA IN SITU OF LIVER AND BILIARY SYSTEM

235.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH INTESTINES AND RECTUM

235.3 NEOPLASM OF UNCERTAIN BEHAVIOR OF LIVER AND BILIARY PASSAGES

235.4 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 MALNUTRITION OF MODERATE DEGREE

263.1 MALNUTRITION OF MILD DEGREE

263.2 ARRESTED DEVELOPMENT FOLLOWING PROTEIN-CALORIE MALNUTRITION

263.8 OTHER PROTEIN-CALORIE MALNUTRITION

263.9 UNSPECIFIED PROTEIN-CALORIE MALNUTRITION

280.0 IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS (CHRONIC)

280.1 IRON DEFICIENCY ANEMIA SECONDARY TO INADEQUATE DIETARY IRON INTAKE

280.8 OTHER SPECIFIED IRON DEFICIENCY ANEMIAS

280.9 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 ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITH BLEEDING

456.21 ESOPHAGEAL VARICES IN DISEASES CLASSIFIED ELSEWHERE WITHOUT BLEEDING

507.0 PNEUMONITIS DUE TO INHALATION OF FOOD OR VOMITUS

530.0 ACHALASIA AND CARDIOSPASM

530.10 ESOPHAGITIS UNSPECIFIED

530.11 REFLUX ESOPHAGITIS

530.12 ACUTE ESOPHAGITIS

530.13 EOSINOPHILIC ESOPHAGITIS

530.19 OTHER ESOPHAGITIS

530.20 ULCER OF ESOPHAGUS WITHOUT BLEEDING

530.21 ULCER OF ESOPHAGUS WITH BLEEDING

530.3 STRICTURE AND STENOSIS OF ESOPHAGUS

530.4 PERFORATION OF ESOPHAGUS

530.5 DYSKINESIA OF ESOPHAGUS

530.6 DIVERTICULUM OF ESOPHAGUS ACQUIRED

530.7 GASTROESOPHAGEAL LACERATION-HEMORRHAGE SYNDROME

530.81 ESOPHAGEAL REFLUX

530.82 ESOPHAGEAL HEMORRHAGE

530.83 ESOPHAGEAL LEUKOPLAKIA

530.84 TRACHEOESOPHAGEAL FISTULA

530.85 BARRETT'S ESOPHAGUS

530.86 INFECTION OF ESOPHAGOSTOMY

530.87 MECHANICAL COMPLICATION OF ESOPHAGOSTOMY

530.89 OTHER DISEASES OF ESOPHAGUS

531.00 ACUTE GASTRIC ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION

531.01 ACUTE GASTRIC ULCER WITH HEMORRHAGE WITH OBSTRUCTION

531.10 ACUTE GASTRIC ULCER WITH PERFORATION WITHOUT OBSTRUCTION

531.11 ACUTE GASTRIC ULCER WITH PERFORATION WITH OBSTRUCTION

531.20 ACUTE GASTRIC ULCER WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

531.21 ACUTE GASTRIC ULCER WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

531.30 ACUTE GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

531.31 ACUTE GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

531.40 CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION

531.41 CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH HEMORRHAGE WITH OBSTRUCTION

531.50 CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH PERFORATION WITHOUT OBSTRUCTION

531.51 CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH PERFORATION WITH OBSTRUCTION

531.60 CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

531.61 CHRONIC OR UNSPECIFIED GASTRIC ULCER WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

531.70 CHRONIC GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

531.71 CHRONIC GASTRIC ULCER WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

531.90 GASTRIC ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

531.91 GASTRIC ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

532.00 ACUTE DUODENAL ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION

532.01 ACUTE DUODENAL ULCER WITH HEMORRHAGE WITH OBSTRUCTION

532.10 ACUTE DUODENAL ULCER WITH PERFORATION WITHOUT OBSTRUCTION

532.11 ACUTE DUODENAL ULCER WITH PERFORATION WITH OBSTRUCTION

532.20 ACUTE DUODENAL ULCER WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

532.21 ACUTE DUODENAL ULCER WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

532.30 ACUTE DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

532.31 ACUTE DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

532.40 CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION

532.41 CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH HEMORRHAGE WITH OBSTRUCTION

532.50 CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH PERFORATION WITHOUT OBSTRUCTION

532.51 CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH PERFORATION WITH OBSTRUCTION

532.60 CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

532.61 CHRONIC OR UNSPECIFIED DUODENAL ULCER WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

532.70 CHRONIC DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

532.71 CHRONIC DUODENAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

532.90 DUODENAL ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

532.91 DUODENAL ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

533.00 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE WITHOUT OBSTRUCTION

533.01 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE WITH OBSTRUCTION

533.10 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH PERFORATION WITHOUT OBSTRUCTION

533.11 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH PERFORATION WITH OBSTRUCTION

533.20 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

533.21 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

533.30 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITHOUT HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

533.31 ACUTE PEPTIC ULCER OF UNSPECIFIED SITE WITHOUT HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

533.40 CHRONIC OR UNSPECIFIED PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE WITHOUT OBSTRUCTION

533.41 CHRONIC OR UNSPECIFIED PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE WITH OBSTRUCTION

533.50 CHRONIC OR UNSPECIFIED PEPTIC ULCER OF UNSPECIFIED SITE WITH PERFORATION WITHOUT OBSTRUCTION

533.51 CHRONIC OR UNSPECIFIED PEPTIC ULCER OF UNSPECIFIED SITE WITH PERFORATION WITH OBSTRUCTION

533.60 CHRONIC OR UNSPECIFIED PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

533.61 CHRONIC OR UNSPECIFIED PEPTIC ULCER OF UNSPECIFIED SITE WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

533.70 CHRONIC PEPTIC ULCER OF UNSPECIFIED SITE WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

533.71 CHRONIC PEPTIC ULCER OF UNSPECIFIED SITE WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

533.90 PEPTIC ULCER OF UNSPECIFIED SITE UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

533.91 PEPTIC ULCER OF UNSPECIFIED SITE UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

534.00 ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION

534.01 ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE WITH OBSTRUCTION

534.10 ACUTE GASTROJEJUNAL ULCER WITH PERFORATION WITHOUT OBSTRUCTION

534.11 ACUTE GASTROJEJUNAL ULCER WITH PERFORATION WITH OBSTRUCTION

534.20 ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

534.21 ACUTE GASTROJEJUNAL ULCER WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

534.30 ACUTE GASTROJEJUNAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

534.31 ACUTE GASTROJEJUNAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

534.40 CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH HEMORRHAGE WITHOUT OBSTRUCTION

534.41 CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH HEMORRHAGE WITH OBSTRUCTION

534.50 CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH PERFORATION WITHOUT OBSTRUCTION

534.51 CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH PERFORATION WITH OBSTRUCTION

534.60 CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH HEMORRHAGE AND PERFORATION WITHOUT OBSTRUCTION

534.61 CHRONIC OR UNSPECIFIED GASTROJEJUNAL ULCER WITH HEMORRHAGE AND PERFORATION WITH OBSTRUCTION

534.70 CHRONIC GASTROJEJUNAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

534.71 CHRONIC GASTROJEJUNAL ULCER WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

534.90 GASTROJEJUNAL ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITHOUT OBSTRUCTION

534.91 GASTROJEJUNAL ULCER UNSPECIFIED AS ACUTE OR CHRONIC WITHOUT HEMORRHAGE OR PERFORATION WITH OBSTRUCTION

535.00 ACUTE GASTRITIS (WITHOUT HEMORRHAGE)

535.01 ACUTE GASTRITIS WITH HEMORRHAGE

535.10 ATROPHIC GASTRITIS (WITHOUT HEMORRHAGE)

535.11 ATROPHIC GASTRITIS WITH HEMORRHAGE

535.20 GASTRIC MUCOSAL HYPERTROPHY (WITHOUT HEMORRHAGE)

535.21 GASTRIC MUCOSAL HYPERTROPHY WITH HEMORRHAGE

535.30 ALCOHOLIC GASTRITIS (WITHOUT HEMORRHAGE)

535.31 ALCOHOLIC GASTRITIS WITH HEMORRHAGE

535.40 OTHER SPECIFIED GASTRITIS (WITHOUT HEMORRHAGE)

535.41 OTHER SPECIFIED GASTRITIS WITH HEMORRHAGE

535.50 UNSPECIFIED GASTRITIS AND GASTRODUODENITIS (WITHOUT HEMORRHAGE)

535.51 UNSPECIFIED GASTRITIS AND GASTRODUODENITIS WITH HEMORRHAGE

535.60 DUODENITIS (WITHOUT HEMORRHAGE)

535.61 DUODENITIS WITH HEMORRHAGE

535.70 EOSINOPHILIC GASTRITIS, WITHOUT MENTION OF HEMORRHAGE

535.71 EOSINOPHILIC GASTRITIS, WITH HEMORRHAGE

536.1 ACUTE DILATATION OF STOMACH

536.2 PERSISTENT VOMITING

536.3 GASTROPARESIS

536.40 GASTROSTOMY COMPLICATION UNSPECIFIED

536.41 INFECTION OF GASTROSTOMY

536.42 MECHANICAL COMPLICATION OF GASTROSTOMY

536.49 OTHER GASTROSTOMY COMPLICATIONS

536.8 DYSPEPSIA AND OTHER SPECIFIED DISORDERS OF FUNCTION OF STOMACH

537.0 ACQUIRED HYPERTROPHIC PYLORIC STENOSIS

537.1 GASTRIC DIVERTICULUM

537.2 CHRONIC DUODENAL ILEUS

537.3 OTHER OBSTRUCTION OF DUODENUM

537.4 FISTULA OF STOMACH OR DUODENUM

537.5 GASTROPTOSIS

537.6 HOURGLASS STRICTURE OR STENOSIS OF STOMACH

537.81 PYLOROSPASM

537.82 ANGIODYSPLASIA OF STOMACH AND DUODENUM (WITHOUT HEMORRHAGE)

537.83 ANGIODYSPLASIA OF STOMACH AND DUODENUM WITH HEMORRHAGE

537.84 DIEULAFOY LESION (HEMORRHAGIC) OF STOMACH AND DUODENUM

537.89 OTHER SPECIFIED DISORDERS OF STOMACH AND DUODENUM

538 GASTROINTESTINAL MUCOSITIS (ULCERATIVE)

551.3 DIAPHRAGMATIC HERNIA WITH GANGRENE

552.3 DIAPHRAGMATIC HERNIA WITH OBSTRUCTION

552.8 HERNIA OF OTHER SPECIFIED SITES WITH OBSTRUCTION

553.3 DIAPHRAGMATIC HERNIA WITHOUT OBSTRUCTION OR GANGRENE

555.0 REGIONAL ENTERITIS OF SMALL INTESTINE

555.1 REGIONAL ENTERITIS OF LARGE INTESTINE

555.2 REGIONAL ENTERITIS OF SMALL INTESTINE WITH LARGE INTESTINE

555.9 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 POUCHITIS

569.79 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 CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS WITHOUT OBSTRUCTION

574.01 CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS WITH OBSTRUCTION

574.10 CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS WITHOUT OBSTRUCTION

574.11 CALCULUS OF GALLBLADDER WITH OTHER CHOLECYSTITIS WITH OBSTRUCTION

574.20 CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS WITHOUT OBSTRUCTION

574.21 CALCULUS OF GALLBLADDER WITHOUT CHOLECYSTITIS WITH OBSTRUCTION

574.30 CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTITIS WITHOUT OBSTRUCTION

574.31 CALCULUS OF BILE DUCT WITH ACUTE CHOLECYSTITIS WITH OBSTRUCTION

574.40 CALCULUS OF BILE DUCT WITH OTHER CHOLECYSTITIS WITHOUT OBSTRUCTION

574.41 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 HEMATEMESIS

578.1 BLOOD IN STOOL

578.9 HEMORRHAGE OF GASTROINTESTINAL TRACT UNSPECIFIED

579.0 CELIAC DISEASE

579.1 TROPICAL SPRUE

579.2 BLIND LOOP SYNDROME

579.3 OTHER AND UNSPECIFIED POSTSURGICAL NONABSORPTION

579.4 PANCREATIC STEATORRHEA

579.8 OTHER SPECIFIED INTESTINAL MALABSORPTION

579.9 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 LOSS OF WEIGHT

783.22 UNDERWEIGHT

783.3 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 POSTNASAL DRIP

784.92 JAW PAIN

784.99 OTHER SYMPTOMS INVOLVING HEAD AND NECK

786.2 COUGH

786.50 UNSPECIFIED CHEST PAIN

786.51 PRECORDIAL PAIN

786.52 PAINFUL RESPIRATION

786.59 OTHER CHEST PAIN

786.6 SWELLING MASS OR LUMP IN CHEST

787.01 NAUSEA WITH VOMITING

787.02 NAUSEA ALONE

787.03 VOMITING ALONE

787.04 BILIOUS EMESIS

787.1 HEARTBURN

787.20 DYSPHAGIA, UNSPECIFIED

787.21 DYSPHAGIA, ORAL PHASE

787.22 DYSPHAGIA, OROPHARYNGEAL PHASE

787.23 DYSPHAGIA, PHARYNGEAL PHASE

787.24 DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE

787.29 OTHER DYSPHAGIA

787.3 FLATULENCE ERUCTATION AND GAS PAIN

787.4 VISIBLE PERISTALSIS

787.5 ABNORMAL BOWEL SOUNDS

787.60 FULL INCONTINENCE OF FECES

787.61 INCOMPLETE DEFECATION

787.62 FECAL SMEARING

787.63 FECAL URGENCY

787.7 ABNORMAL FECES

787.91 DIARRHEA

789.00 ABDOMINAL PAIN UNSPECIFIED SITE

789.01 ABDOMINAL PAIN RIGHT UPPER QUADRANT

789.02 ABDOMINAL PAIN LEFT UPPER QUADRANT

789.03 ABDOMINAL PAIN RIGHT LOWER QUADRANT

789.04 ABDOMINAL PAIN LEFT LOWER QUADRANT

789.05 ABDOMINAL PAIN PERIUMBILIC

789.06 ABDOMINAL PAIN EPIGASTRIC

789.07 ABDOMINAL PAIN GENERALIZED

789.09 ABDOMINAL PAIN OTHER SPECIFIED SITE

789.30 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP UNSPECIFIED SITE

789.31 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP RIGHT UPPER QUARDANT

789.32 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP LEFT UPPER QUADRANT

789.33 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP RIGHT LOWER QUADRANT

789.34 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP LEFT LOWER QUADRANT

789.35 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP PERIUMBILIC

789.36 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP EPIGASTRIC

789.37 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP GENERALIZED

789.39 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP OTHER SPECIFIED SITE

789.51 MALIGNANT ASCITES

789.59 OTHER ASCITES

789.60 ABDOMINAL TENDERNESS UNSPECIFIED SITE

789.61 ABDOMINAL TENDERNESS RIGHT UPPER QUADRANT

789.62 ABDOMINAL TENDERNESS LEFT UPPER QUADRANT

789.63 ABDOMINAL TENDERNESS RIGHT LOWER QUADRANT

789.64 ABDOMINAL TENDERNESS LEFT LOWER QUADRANT

789.65 ABDOMINAL TENDERNESS PERIUMBILIC

789.66 ABDOMINAL TENDERNESS EPIGASTRIC

789.67 ABDOMINAL TENDERNESS GENERALIZED

789.69 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 OPEN WOUND OF PHARYNX WITHOUT COMPLICATION

874.5 OPEN WOUND OF PHARYNX COMPLICATED

935.1 FOREIGN BODY IN ESOPHAGUS

935.2 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 BURN OF ESOPHAGUS

947.3 BURN OF GASTROINTESTINAL TRACT

959.01 OTHER AND UNSPECIFIED INJURY TO HEAD

959.09 OTHER AND UNSPECIFIED INJURY TO FACE AND NECK

983.2 TOXIC EFFECT OF CAUSTIC ALKALIS

983.9 TOXIC EFFECT OF CAUSTIC UNSPECIFIED

990 EFFECTS OF RADIATION UNSPECIFIED

996.82 COMPLICATIONS OF TRANSPLANTED LIVER

997.41 RETAINED CHOLELITHIASIS FOLLOWING CHOLECYSTECTOMY

997.49 OTHER DIGESTIVE SYSTEM COMPLICATIONS

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 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF ESOPHAGUS

V10.04 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 FAMILY HISTORY, COLONIC POLYPS

V18.59 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 ANTI-INFLAMMATORIES

V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS

V69.1 INAPPROPRIATE DIET AND EATING HABITS

* 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.

 

 

Documentation Requirements

• The patient’s medical record (e.g., history and physical, office/progress notes, procedure report) maintained by the ordering/referring physician must clearly indicate the reason for the EGD.

o Also, the results of the EGD must be included in the patient’s medical record.

• The CMS Manual System, Pub. 100-8, Program Integrity Manual, Chapter 13, Section 5.1 (http://www.cms.hhs.gov/manuals/downloads/pim83c13.pdf) outlines that "reasonable and necessary" services are "ordered and/or furnished by qualified personnel."

o A qualified physician for this service/procedure is defined as follows:

 A) Physician is properly enrolled in Medicare.

 B) Training and expertise

• Must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty in the United States.

Or

• Must reflect equivalent education, training, and expertise endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States.

o This service will be considered medically reasonable and necessary only if performed by providers of gastroenterology services, or other providers who have specialized training and expertise in performing the procedure in question.

 

 

Treatment Logic:

• Upper intestinal endoscopy is performed with a lighted, flexible, fiberoptic instrument passed through the cricopharynx.

o The patient receives conscious sedation.

o A topical anesthetic is sometimes applied to the posterior pharynx.

o Direct visualization of the entire esophagus, stomach, and duodenum (to the junction of the second and third portions) can be accomplished easily with modern instruments that are less than 12mm in diameter.

o Esophagogastroduodenoscopy (EGD) is a technique utilized to examine, obtain samples, and in some instances, to treat pathological conditions.

• Diagnostic observations are made concerning focal benign or malignant lesions, diffuse mucosal changes, luminal obstruction, motility, and extrinsic compression by contiguous structures.

• A diagnostic EGD allows the examiner to visualize abnormalities detectable by the technique and to photograph, biopsy, and/or remove lesions as appropriate.

• The purpose of the therapeutic EGD is to

o Manage hemorrhage.

o Remove foreign bodies and neoplastic growths.

o To relieve obstruction due to stricture, malignancy.

o Other causes through dilatation or the placement of stents.

o Assist in the placement of percutaneous gastrostomy tubes.

 

 

Sources of Information and Basis for Decision

 

American Society of Gastrointestinal Endoscopy. Appropriate use of gastrointestinal endoscopy. Gastrointestinal Endoscopy, 52(6) 831-7.

 

Cappell, M.S., & Friedel, D. (2002). The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders. The Medical Clinics of North America 86(6) pg 1165-1216.

 

FCSO LCD 29167, 10/01/2011, Diagnostic and Therapeutic Esophagogastroduodenoscopy. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply.

 

 

CMS LCD DIAGNOSTIC AND THERAPEUTIC ESOPHAGOGASTRODUODENOSCOPY