Assign Endoscopy Codes - Certified Professional Coder CPC

1. During an EGD, the gastroenterologist takes a biopsy of the gastric mucosa to rule out H. pylori infection. Which CPT® code is reported?
   Answer: 43239 CPT® 43239 covers upper GI endoscopy with biopsy, single or multiple. Code 43235 is diagnostic EGD without biopsy; 43236 covers submucosal injection; 43238 covers EGD with ultrasound-guided fine needle aspiration. When a biopsy is taken during an EGD — regardless of the number of biopsy sites — 43239 is reported. The diagnostic EGD (43235) is not additionally reported as it is bundled into 43239.
2. A gastroenterologist performs a colonoscopy and places a self-expanding metallic stent to relieve a malignant colonic obstruction. Which CPT® code covers colonoscopy with endoscopic stent placement?
   Answer: 45389 CPT® 45389 covers colonoscopy with endoscopic stent placement. Code 45386 covers balloon dilation of the colon; 45388 covers ablation; 45399 is an unlisted colonoscopy procedure. Stent placement for relief of colonic obstruction — benign or malignant — is reported with 45389. This is a distinct therapeutic intervention from dilation (45386) or ablation (45388).
3. A gastroenterologist performs a colonoscopy with submucosal injection of a lifting agent beneath a flat lesion prior to endoscopic mucosal resection. Which CPT® code covers colonoscopy with submucosal injection?
   Answer: 45381 CPT® 45381 covers colonoscopy with directed submucosal injection(s), any substance. This code is used when submucosal injection is performed for tattoo marking, polyp lifting, or other therapeutic purposes. Code 45382 covers control of bleeding; 45384 covers removal by hot biopsy forceps; 45386 covers balloon dilation. Submucosal injection as a standalone procedure is coded with 45381.
4. A surgeon performs a diagnostic laparoscopy of the abdominal cavity to evaluate a patient with chronic pelvic pain. No therapeutic procedure is performed. Which CPT® code covers diagnostic laparoscopy?
   Answer: 49320 CPT® 49320 covers diagnostic laparoscopy, abdominopelvic, with or without collection of specimen(s) by brushing or washing. For a diagnostic laparoscopy without biopsy or aspiration, 49320 is the correct code. Code 49321 covers laparoscopy with biopsy; 49322 covers laparoscopy with aspiration of a cyst or abscess. When no therapeutic procedure is performed, 49320 is the appropriate diagnostic code.
5. A urologist performs a cystoscopy with laser fulguration of multiple bladder lesions. The documented lesion size is 1.5 cm. Which CPT® code covers cystoscopy with fulguration of bladder tumor(s) between 0.5 cm and 2.0 cm?
   Answer: 52234 CPT® 52234 covers cystourethroscopy with fulguration (including laser surgery) of small bladder tumor(s) 0.5 cm to 2.0 cm. Code 52204 covers biopsy; 52214 covers fulguration of minor lesions without size specification; 52224 covers lesions less than 0.5 cm. For a documented lesion of 1.5 cm, 52234 is the appropriate code. Lesion size drives the code selection within the cystoscopy fulguration range.
6. A gastroenterologist performs a colonoscopy through a patient's colostomy to evaluate the proximal colon. Which CPT® code covers colonoscopy through a stoma?
   Answer: 44388 CPT® 44388 covers colonoscopy through a stoma — diagnostic, including collection of specimen(s) by brushing or washing, when performed. Codes beginning with 44 cover endoscopy through a stoma; codes beginning with 45 cover transanal (standard) colonoscopy. When the colon is accessed through a surgical stoma rather than the anus, 44388 (and related 44389-44408 for therapeutic procedures) is the appropriate code range.
7. A gastroenterologist begins a colonoscopy in an outpatient facility. Conscious sedation is administered. After advancing the scope to the hepatic flexure, the procedure is discontinued because the patient cannot tolerate further advancement. Which code is reported?
   Answer: 45378-74 Modifier -74 (discontinued outpatient hospital/ASC procedure after anesthesia) is appended to 45378 when a planned procedure is discontinued in an outpatient facility or ASC after conscious sedation or anesthesia has been administered but before the procedure is completed. Code 45378-74 captures this scenario. Modifier -52 applies to reduced services in a non-facility context; modifier -53 applies when a procedure is discontinued due to extenuating circumstances threatening patient wellbeing, typically without pre-administered anesthesia.
8. A pulmonologist performs a flexible bronchoscopy and obtains bronchoalveolar lavage (BAL) to evaluate for pneumonia in an immunocompromised patient. Which CPT® code covers bronchoscopy with BAL?
   Answer: 31624 CPT® 31624 covers bronchoscopy, flexible, with bronchial alveolar lavage (BAL). Code 31622 covers diagnostic bronchoscopy; 31623 covers bronchoscopy with brushing; 31625 covers bronchoscopy with bronchial biopsy. BAL — the instillation and aspiration of saline to collect cells from the alveoli — is a distinct technique from bronchial brushing or biopsy, coded separately with 31624.
9. A gastroenterologist performs a diagnostic colonoscopy on a 55-year-old patient. No polyps or abnormalities are found, and no therapeutic procedures are performed. Which CPT® code is reported?
   Answer: 45378 CPT® 45378 covers diagnostic colonoscopy — colonoscopy through the entire colon from the rectum to the cecum with image documentation, including when no therapeutic procedure is performed. Code 45380 covers colonoscopy with biopsy; 45385 covers colonoscopy with snare polypectomy; 45386 covers colonoscopy with dilation. The diagnostic code (45378) is reported when the scope reaches the cecum and no intervention is performed.
10. A surgeon performs a surgical arthroscopy of the right shoulder with rotator cuff repair. Which CPT® code covers arthroscopic rotator cuff repair?
    Answer: 29827 CPT® 29827 covers arthroscopy, shoulder, surgical, with rotator cuff repair. Code 29806 covers arthroscopy with capsulorraphy; 29819 covers arthroscopy with removal of loose body or foreign body; 29821 covers arthroscopy with synovectomy, complete. Rotator cuff repair is specifically designated 29827 within the shoulder arthroscopy surgical codes. This is one of the most commonly tested shoulder arthroscopy codes on the CPC exam.
11. A physician performs a diagnostic flexible sigmoidoscopy, advancing the scope to the splenic flexure with no interventions. Which CPT® code is reported?
    Answer: 45330 CPT® 45330 covers flexible sigmoidoscopy — diagnostic, including collection of specimen(s) by brushing or washing, when performed. Code 45331 covers sigmoidoscopy with biopsy; 45332 covers sigmoidoscopy with removal of foreign body; 45378 is colonoscopy (full colon to cecum). The flexible sigmoidoscopy codes (45330-45345) apply when the scope does not advance beyond the splenic flexure. A full colonoscopy to the cecum is coded separately.
12. A flexible esophagoscopy is performed to evaluate dysphagia. The scope evaluates only the esophagus and does not pass into the stomach. Which CPT® code covers diagnostic flexible esophagoscopy?
    Answer: 43197 CPT® 43197 covers flexible esophagoscopy, diagnostic, with or without collection of specimen(s) by brushing or washing. Esophagoscopy codes (43191-43232) cover the esophagus only and are used when the examination does not extend into the stomach or beyond the gastroesophageal junction. Code 43235 covers EGD — esophagus, stomach, and upper small intestine; 43191 covers rigid esophagoscopy; 43200 covers flexible esophagoscopy with injection.
13. A gastroenterologist performs a diagnostic upper GI endoscopy (EGD) to evaluate dyspepsia. The scope passes through the esophagus, stomach, and proximal duodenum. No interventions are performed. Which CPT® code is reported?
    Answer: 43235 CPT® 43235 covers upper gastrointestinal endoscopy (EGD), diagnostic — esophagus, stomach, and/or upper small intestine with or without collection of specimen by brushing or washing. Code 43239 covers EGD with biopsy; 43250 covers EGD with tumor removal by hot biopsy forceps; 43237 covers EGD with ultrasound examination. When no therapeutic procedure is performed, the diagnostic EGD code (43235) is reported.
14. A gastroenterologist performs a colonoscopy with removal of a pedunculated polyp using a hot snare polypectomy technique. Which CPT® code is reported?
    Answer: 45385 CPT® 45385 covers colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by snare technique. Code 45378 is diagnostic only; 45380 covers biopsy; 45384 covers removal by hot biopsy forceps. Hot snare polypectomy is specifically captured by 45385. The technique used for polyp removal determines the code selection within the therapeutic colonoscopy range.
15. A gastroenterologist performs an EGD with balloon dilation of an esophageal stricture (balloon diameter less than 30 mm). Which CPT® code covers EGD with esophageal balloon dilation?
    Answer: 43249 CPT® 43249 covers upper GI endoscopy with balloon dilation of the esophagus less than 30 mm in diameter. Code 43220 covers esophageal dilation with balloon 30 mm diameter or greater; 43245 covers dilation of the gastric outlet (pylorus); 43248 covers esophageal dilation using guided wire technique. The balloon diameter threshold determines whether 43249 (less than 30 mm) or 43220 (30 mm or greater) applies.
16. A gynecologist performs a diagnostic hysteroscopy to evaluate abnormal uterine bleeding. No therapeutic procedures are performed. Which CPT® code covers diagnostic hysteroscopy?
    Answer: 58555 CPT® 58555 covers hysteroscopy, diagnostic (separate procedure) — used when hysteroscopy is performed for evaluation only, without any therapeutic intervention. Code 58558 covers hysteroscopy with sampling (biopsy) of endometrium; 58560 covers hysteroscopy with division of intrauterine septum; 58559 covers hysteroscopy with lysis of intrauterine adhesions. When no biopsy or therapeutic procedure is performed, only the diagnostic code 58555 is reported.
17. An endoscopist performs an EGD with ligation (banding) of esophageal varices. Which CPT® code covers EGD with variceal band ligation?
    Answer: 43244 CPT® 43244 covers upper GI endoscopy with band ligation of esophageal and/or gastric varices. Code 43243 covers EGD with injection of esophageal/gastric varices; 43245 covers dilation of the gastric outlet; 43246 covers placement of a percutaneous gastrostomy tube. Band ligation is a specific technique for variceal treatment distinct from injection sclerotherapy (43243), each having its own code.
18. A surgeon performs a laparoscopic cholecystectomy. Which rule applies to the diagnostic laparoscopy performed at the same session as the therapeutic procedure?
    Answer: Diagnostic laparoscopy performed at the same session as a therapeutic laparoscopic procedure is bundled and not separately reportable When a diagnostic laparoscopy is performed immediately before and as the approach to a definitive therapeutic laparoscopic procedure by the same surgeon, it is bundled into the therapeutic code. CPT® guidelines and NCCI bundle 49320 into the more comprehensive therapeutic laparoscopic service. Only the therapeutic procedure code is reported.
19. A pulmonologist performs a flexible bronchoscopy with transbronchial lung biopsy (TBLB) of the right lower lobe. Which CPT® code covers bronchoscopy with transbronchial lung biopsy?
    Answer: 31628 CPT® 31628 covers bronchoscopy, flexible, with transbronchial lung biopsy(ies), single lobe. Code 31622 covers diagnostic bronchoscopy only; 31625 covers bronchoscopy with bronchial or endobronchial biopsy (not lung parenchyma); 31629 covers transbronchial needle aspiration biopsy. TBLB is a parenchymal lung biopsy obtained through the bronchoscope and is specifically coded with 31628.
20. A gastroenterologist performs a colonoscopy and ablates two flat polyps in the transverse colon using argon plasma coagulation. Which CPT® code is reported?
    Answer: 45388 CPT® 45388 covers colonoscopy with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by snare or hot biopsy forceps. When flat polyps require ablation rather than mechanical removal, 45388 is the appropriate code. Code 45385 covers snare polypectomy; 45378 is diagnostic only; 45382 covers control of bleeding. The technique of removal or destruction determines the correct colonoscopy code.

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