CPT for gastroenterology

Common Gastroenterology CPT Codes: Descriptions, Time Frames, and Bundling Rules

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Introduction:

Gastroenterology is one of the most procedure-heavy specialties in medicine. Accurate use of CPT codes is critical not only for reimbursement but also for compliance with payer policies. Below is a curated list of commonly used GI CPT codes, including their descriptions, time frame requirements, bundling restrictions, and usage conditions.

What is CPTS for Gastroenterology?

CPTS, short for Clinical Practice Technology Solutions, is a comprehensive software platform designed to help specialty practices manage clinical, administrative, and financial operations in one place. Unlike a traditional EHR that often feels generic and overloaded, CPTS is tailored to specialty workflows—for gastroenterology, this means:

  • Endoscopy scheduling and documentation
  • Integration with diagnostic imaging and lab systems
  • CPT and ICD-10 coding accuracy for GI-specific procedures
  • Billing compliance for complex gastroenterology services
  • Patient engagement tools for chronic conditions like Crohn’s disease, ulcerative colitis, or GERD

In essence, CPTS combines the benefits of a billing platform, scheduling tool, and documentation system, but tuned to the unique needs of GI practices.

1. Colonoscopy Codes (45378 – 45398)

  • 45378 – Diagnostic colonoscopy, including collection of specimen(s) by brushing or washing, when performed (separate procedure).
    • Time Frame: No specific time requirement; coded per procedure.
    • Bundling: Includes insertion and removal of scope; can’t be billed separately.
    • When to Use: For diagnostic visualization without biopsy or polyp removal.
  • 45380 – Colonoscopy with biopsy, single or multiple.
    • Bundling: Don’t bill with 45378; the biopsy supersedes diagnostic.
    • When to Use: When tissue is sampled for pathology.
  • 45385 – Colonoscopy with polypectomy (snare technique).
    • Bundling: Supersedes diagnostic colonoscopy.
    • When to Use: For polyp removal by snare, regardless of number of polyps.

2. Esophagogastroduodenoscopy (EGD) Codes (43235 – 43259)

  • 43235 – Diagnostic EGD (esophagus, stomach, and duodenum).
    • When to Use: For visualization only, without biopsy.
  • 43239 – EGD with biopsy, single or multiple.
    • Bundling: Cannot bill diagnostic + biopsy together; biopsy code prevails.
    • When to Use: For sampling gastric or esophageal tissue.
  • 43249 – EGD with balloon dilation (less than 30 mm diameter).
    • When to Use: For esophageal strictures or achalasia.
  • 43251 – EGD with removal of tumor(s), polyp(s), or other lesion(s).
    • When to Use: For lesion excision beyond biopsy.

3. Endoscopic Ultrasound (EUS) Codes (43231 – 43259)

  • 43242 – EUS with fine-needle aspiration (FNA).
    • Bundling: Includes imaging guidance; don’t separately bill ultrasound guidance.
    • When to Use: For pancreatic, esophageal, or gastric lesion evaluation.
  • 43259 – EUS, diagnostic, including esophagus, stomach, and duodenum, and adjacent structures.
    • When to Use: For detailed imaging when no FNA is performed.

4. Therapeutic Gastroenterology Codes

  • 43450 – Dilation of esophagus, single or multiple, with bougie.
    • When to Use: For benign stricture dilation.
  • 43460 – Dilation of esophagus with balloon (≥30 mm diameter).
    • When to Use: For larger strictures or achalasia.
  • 43248 – EGD with dilation of esophagus (balloon, <30 mm).
    • Bundling: More specific than 43450; code based on technique.

5. Time-Based GI Procedure Codes

Some gastroenterology codes are time-dependent, particularly when involving prolonged services, anesthesia monitoring, or infusion therapy.

  • 99152 – Moderate sedation, initial 15 minutes, for patients aged 5 years or older.
  • 99153 – Each additional 15 minutes.
    • When to Use: Only if physician or qualified health professional personally provides sedation; document start and stop times.
    • Bundling: Typically bundled into procedural codes if performed by same physician; bill separately if distinct provider monitors sedation.

6. Bundling and Modifier Rules in Gastroenterology

  • Diagnostic vs Therapeutic Procedures: If both are performed, report only the therapeutic CPT (e.g., biopsy, polypectomy).
  • Modifier 59: Use to override bundling edits when two distinct procedures are legitimately performed. Example: Colonoscopy with polypectomy in one segment and biopsy in another.
  • Separate Session Documentation: Always document medical necessity and procedural detail when using modifiers.

7. Conditions for Using Gastroenterology CPT Codes

  • Medical Necessity: Codes should always reflect documented necessity (e.g., bleeding, suspected cancer, IBD monitoring).
  • Time Documentation: For time-based codes, providers must record start and stop times.
  • Bundling Awareness: Avoid unbundling procedures that are inherently included in another code.
  • Correct Sequencing: Always assign the code reflecting the most extensive procedure performed.

Major Procedures in Gastroenterology: CPT Code Reference Table

The following table highlights the most frequently billed procedures in gastroenterology, along with their CPT codes and concise descriptions. This can serve as a go-to reference for billers, coders, and providers.

CPT CodeProcedureDescription
45378Diagnostic ColonoscopyVisualization of colon; includes specimen collection by brushing or washing when performed.
45380Colonoscopy with BiopsyColonoscopy with single or multiple biopsies for pathology.
45385Colonoscopy with PolypectomyRemoval of polyp(s) by snare technique during colonoscopy.
45384Colonoscopy with Hot Biopsy ForcepsRemoval of tumor(s), polyp(s), or lesion(s) using hot biopsy technique.
43235Diagnostic EGDVisualization of esophagus, stomach, and duodenum.
43239EGD with BiopsyEsophagogastroduodenoscopy with biopsy (single or multiple).
43249EGD with Balloon DilationDilation of esophagus with balloon (<30 mm).
43242EUS with FNAEndoscopic ultrasound with fine needle aspiration (includes guidance).
43259Diagnostic EUSEndoscopic ultrasound of esophagus, stomach, and duodenum (no FNA).
43450Esophageal Dilation (Bougie)Dilation of esophagus using bougie, single or multiple.
43460Esophageal Dilation (Balloon ≥30 mm)Dilation of esophagus using balloon dilation (≥30 mm).
91110Wireless Capsule EndoscopySmall bowel capsule endoscopy, includes interpretation and report.
91112Capsule Endoscopy with ileum visualizationExtended capsule endoscopy with ileum study.
99152Moderate Sedation (Initial 15 min)Moderate sedation provided by physician or qualified health professional (patients ≥5 yrs).
99153Moderate Sedation (Each Additional 15 min)Add-on for extended sedation time beyond initial 15 min.

Final Takeaway

CPTS for gastroenterology isn’t just another buzzword it’s a practical solution for practices looking to balance clinical excellence with financial stability. By carefully evaluating features, pricing, and vendor support, practices can choose the right platform to simplify operations, improve patient care, and maximize revenue.

Whether you’re shopping for the best CPTS software for gastroenterology, comparing subscription plans, or exploring alternatives, the key is to align the system with your practice’s long-term goals.

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