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October, 2026
EGD CPT Codes 43235–43270: Esophagogastroduodenoscopy Coding Guide
Category: Cpt Codes
The base CPT code for an EGD (esophagogastroduodenoscopy) is 43235, a diagnostic flexible transoral upper endoscopy. When the physician takes a biopsy, report 43239 instead. Therapeutic EGDs have their own codes in the 43233–43270 range, such as 43249 for balloon dilation of the esophagus, 43246 for PEG tube placement and 43259 for endoscopic ultrasound.
EGD is the most frequently billed upper GI procedure, and its code family has strict bundling rules. Choosing 43235 when a biopsy was taken, or billing two dilation codes together, quietly costs GI practices money. At AffinityCore, our gastroenterology coders work with these codes every day. This guide lists every EGD CPT code, matches each one to real procedures, and covers the related ICD-10, EUS, ERCP and enteroscopy codes.
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What Is CPT Code 43235?
CPT 43235 description: Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure).
An EGD, also called an upper endoscopy, upper GI endoscopy or gastroscopy, examines the esophagus, stomach and at least the first part of the duodenum with a flexible scope passed through the mouth. CPT 43235 is the diagnostic version: the physician looks, and may collect cells by brushing or washing, but doesn’t treat anything.
Three rules govern 43235:
- It’s the base code for the family. Every therapeutic EGD code from 43236 to 43270 includes the diagnostic EGD, so never bill 43235 with another EGD code on the same session.
- “Separate procedure” status. 43235 is only reported alone when no other EGD service is performed.
- Reaching the duodenum matters. If the scope doesn’t pass the pylorus, the service is an esophagoscopy (43197–43232) or an EGD with modifier 52 (reduced service) when the physician meant to complete the exam, depending on documentation and payer policy.
What is CPT code 43239?
CPT 43239 is an EGD, flexible, transoral; with biopsy, single or multiple. It’s billed once per session, however many biopsies are taken and from however many sites. 43239 replaces 43235 whenever a biopsy is taken.
Complete EGD CPT Code List (2027)
All codes below describe a flexible, transoral esophagogastroduodenoscopy. Descriptors are shortened; check the CPT manual for full wording.
| CPT code | EGD with… |
| 43235 | Diagnostic, with brushing or washing when performed |
| 43236 | Directed submucosal injection(s), any substance |
| 43237 | Endoscopic ultrasound (EUS) limited to esophagus, stomach or duodenum and adjacent structures |
| 43238 | EUS-guided intramural or transmural fine-needle aspiration/biopsy (limited EUS) |
| 43239 | Biopsy, single or multiple |
| 43240 | Transmural drainage of pseudocyst (includes stent and EUS when performed) |
| 43241 | Insertion of intraluminal tube or catheter |
| 43242 | EUS-guided FNA/biopsy with full EUS (esophagus, stomach, duodenum or altered anatomy) |
| 43243 | Injection sclerosis of esophageal/gastric varices |
| 43244 | Band ligation of esophageal/gastric varices |
| 43245 | Dilation of gastric/duodenal stricture(s), balloon or bougie |
| 43246 | Directed placement of percutaneous gastrostomy (PEG) tube |
| 43247 | Removal of foreign body(s) |
| 43248 | Guide wire insertion followed by passage of dilator(s) through the esophagus |
| 43249 | Transendoscopic balloon dilation of esophagus, less than 30 mm |
| 43233 | Balloon dilation of esophagus, 30 mm or larger (includes fluoroscopy when performed) |
| 43250 | Removal of tumor/polyp/lesion by hot biopsy forceps |
| 43251 | Removal of tumor/polyp/lesion by snare technique |
| 43252 | Optical endomicroscopy |
| 43253 | EUS-guided transmural injection of diagnostic/therapeutic substance or fiducial markers |
| 43254 | Endoscopic mucosal resection (EMR) |
| 43255 | Control of bleeding, any method |
| 43257 | Delivery of thermal energy to the lower esophageal sphincter/gastric cardia for GERD |
| 43259 | EUS of esophagus, stomach and duodenum or surgically altered stomach |
| 43266 | Placement of endoscopic stent (includes pre/post-dilation and guide wire) |
| 43270 | Ablation of tumor/polyp/lesion (includes pre/post-dilation and guide wire) |
| 43210 | Esophagogastric fundoplasty, partial or complete (transoral incisionless fundoplication) |
New for 2027: CPT 43889 reports endoscopic sleeve gastroplasty (ESG), a transoral gastric restrictive procedure. It replaces the HCPCS and unlisted codes previously used and carries a 90-day global period.
Which EGD CPT Code Do I Use? Common Scenarios
| Procedure performed | CPT code(s) | Coding note |
| EGD, look only | 43235 | Never with another EGD code |
| EGD with biopsy (any number) | 43239 × 1 | Replaces 43235 |
| EGD with balloon dilation of esophagus (<30 mm) | 43249 | Most common “EGD with dilation” code |
| EGD with balloon dilation of esophagus (≥30 mm, e.g. achalasia) | 43233 | Includes fluoroscopy when performed |
| EGD with Savary (wire-guided bougie) dilation | 43248 | |
| EGD with dilation of gastric or duodenal stricture | 43245 | Different site from the esophagus |
| EGD with biopsy and esophageal dilation | 43239 + 43249 | Both payable; multiple endoscopy rule applies |
| EGD with variceal banding | 43244 | |
| EGD with Botox injection (e.g. LES for achalasia) | 43236 | Submucosal injection, any substance; bill the drug separately |
| EGD with argon plasma coagulation (APC) to stop bleeding | 43255 | Control of bleeding, any method |
| EGD with APC to ablate a lesion (e.g. GAVE, Barrett’s) | 43270 | Ablation of lesion |
| EGD with PEG tube placement | 43246 | |
| EGD with stent placement | 43266 | Includes dilation and guide wire |
| EGD with stent removal | 43247 | Usually reported as foreign body removal; confirm payer policy |
| EGD with polyp removal by snare | 43251 | |
| EGD with endoscopic mucosal resection | 43254 | |
| EGD with Bravo pH capsule placement | EGD code + 91035 | 91035 = telemetry pH electrode placement and recording |
Rules that change the code
- One esophageal dilation code per session. 43233, 43248 and 43249 are mutually exclusive. If the physician uses two techniques, report the one that best describes the final dilation.
- Biopsy and removal of the same lesion: report only the removal code. Biopsy of a different lesion can be added with modifier XS or 59.
- Stent placement (43266) and ablation (43270) already include pre- and post-dilation and guide wire passage. Don’t add 43248 or 43249.
- Incomplete EGD: use modifier 52 when the procedure was reduced, or 53 when it was stopped because of patient risk.
Endoscopic Ultrasound (EUS) CPT Codes
Upper EUS codes are part of the EGD family. The right code depends on how far the EUS exam went and whether a needle aspiration or biopsy was done.
| EUS service | CPT code |
| Upper EUS, full exam (esophagus, stomach and duodenum or altered anatomy) | 43259 |
| Upper EUS, limited to esophagus, stomach or duodenum and adjacent structures | 43237 |
| Upper EUS with FNA/FNB, full exam | 43242 |
| Upper EUS with FNA/FNB, limited exam | 43238 |
| EUS-guided transmural injection or fiducial placement (e.g. celiac plexus block) | 43253 |
| EUS-guided pseudocyst drainage | 43240 |
FNA codes include the EUS exam: don’t bill 43259 with 43242, or 43237 with 43238. Lower GI EUS has its own codes in the sigmoidoscopy and colonoscopy families.
Other Upper GI and Endoscopy CPT Codes
| Procedure | CPT code(s) | Note |
| ERCP, diagnostic | 43260 | Base code for the ERCP family |
| ERCP with sphincterotomy | 43262 | |
| ERCP with removal of stones or debris | 43264 | |
| ERCP with stent placement / stent removal and exchange | 43274 / 43276 | 43275 for stent or foreign body removal only |
| Push enteroscopy, diagnostic / with biopsy | 44360 / 44361 | Beyond the 2nd portion of the duodenum, not including ileum |
| Enteroscopy including ileum, diagnostic | 44376 | Deep (balloon-assisted) enteroscopy |
| Pouchoscopy (ileal pouch), diagnostic / with biopsy | 44385 / 44386 | |
| Ileoscopy through stoma, diagnostic / with biopsy | 44380 / 44382 | |
| Esophagoscopy, flexible transoral, diagnostic / with biopsy | 43200 / 43202 | When the scope doesn’t go past the esophagus |
| Esophageal dilation without endoscopy (bougie) | 43450 | Wire-guided version: 43453 |
| EndoFLIP (esophageal balloon distension study) | 91040 | Coverage varies; many payers need prior auth or consider it investigational |
| Bravo esophageal pH capsule | 91035 | Add the EGD code if a diagnostic EGD is also done |
| Upper GI series, single / double contrast | 74240 / 74246 | Add 74248 for small bowel follow-through |
| Barium enema, double contrast (air contrast) | 74280 | |
| Colonoscopy with EMR | 45390 | |
| Endoscopic sleeve gastroplasty (new 2027) | 43889 | 90-day global |
EGD and colonoscopy on the same day
When a patient has an EGD and a colonoscopy in one session, bill both procedures, for example 43239 + 45380. They belong to different endoscopy families, so each is paid, with the standard multiple-procedure reduction on the lower-valued code. Anesthesia for the combined session is reported with 00813 (combined upper and lower GI endoscopy) rather than 00731 + 00811.
Anesthesia for EGD
Anesthesia for an EGD is 00731, anesthesia for upper GI endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified (abbreviated “ANES UPR GI NDSC PX NOS” in fee schedules). ERCP anesthesia is 00732.
ICD-10 Codes for EGD
There’s no single “EGD” ICD-10-CM code. The diagnosis code is the reason for the endoscopy, and it must support medical necessity for the CPT code.
| Indication | ICD-10-CM code |
| Dysphagia, unspecified | R13.10 |
| GERD without esophagitis / with esophagitis, without bleeding | K21.9 / K21.00 |
| Epigastric pain | R10.13 |
| Nausea with vomiting | R11.2 |
| GI bleeding, unspecified | K92.2 |
| Iron deficiency anemia, unspecified | D50.9 |
| Barrett’s esophagus without dysplasia | K22.70 |
| Gastritis, unspecified, without bleeding | K29.70 |
| Gastric ulcer, unspecified | K25.9 |
| Screening for malignant neoplasm of stomach | Z12.0 |
If the EGD finds something, code the finding (e.g. K21.00 esophagitis), not just the presenting symptom. When biopsies are taken, update the diagnosis once pathology is back if your workflow allows it.
ICD-10-PCS codes for EGD (inpatient)
Hospitals report inpatient EGDs with ICD-10-PCS, using the endoscopic, via natural opening approach (character 8):
| Inpatient procedure | ICD-10-PCS code |
| Diagnostic EGD (inspection of upper intestinal tract) | 0DJ08ZZ |
| EGD with biopsy of stomach | 0DB68ZX |
| EGD with biopsy of esophagus / duodenum | 0DB58ZX / 0DB98ZX |
| EGD with esophageal dilation | 0D758ZZ |
| PEG tube placement | 0DH64UZ |
Multiple Endoscopy Rule, Modifiers and Common EGD Denials
How Medicare pays multiple EGD codes
When two or more codes from the EGD family are billed in one session, Medicare applies the special endoscopy rule. The highest-valued procedure is paid in full. Each additional procedure is paid at its value minus the value of the base code (43235), because the diagnostic EGD is already counted once. Codes from different families, such as an EGD and a colonoscopy, follow the standard multiple-procedure reduction instead.
Modifiers used with EGD codes
- XS / 59: separate lesion or site, such as a biopsy of one lesion and snare removal of another
- 52: reduced service, such as an EGD that couldn’t reach the duodenum
- 53: procedure stopped because of a threat to the patient’s well-being
- PT / 33: a screening colonoscopy that became diagnostic in the same session (relevant for combined EGD and colonoscopy)
Common EGD coding errors
| Error | Result | Fix |
| 43235 billed with 43239 or another EGD code | NCCI denial | Report only the therapeutic code(s) |
| 43239 billed per biopsy | Units denied | 43239 × 1, whatever the number of biopsies |
| Two esophageal dilation codes | Denial of one | Pick 43233, 43248 or 43249 |
| 43249 added to stent placement (43266) | Bundled | Dilation is included in 43266 and 43270 |
| 43259 with 43242 | Bundled | 43242 includes the full EUS |
| Symptom code only when a finding was documented | Medical necessity or audit risk | Code the endoscopic finding |
| No prior authorization for EUS or EndoFLIP | Front-end denial | Check payer auth rules at scheduling |
How AffinityCore Helps GI Practices Get Endoscopy Claims Paid
AffinityCore gives gastroenterology practices and ASCs certified coders who know the EGD, EUS, ERCP and colonoscopy families in detail.
- Gastroenterology billing: EGD, colonoscopy, EUS and ERCP claims coded to the op note, with NCCI bundling and the multiple endoscopy rule applied correctly.
- Certified medical coding: every therapeutic service captured: no missed biopsies, dilations or Bravo placements, and no duplicate base codes.
- Prior authorization support: EUS, EndoFLIP and other high-cost services are authorized before the patient arrives, reducing GI prior-auth delays.
- Denial management: bundling and medical necessity denials are corrected and appealed quickly.
- Anesthesia billing: 00731, 00732 and 00813 claims with correct time units and modifiers.
Losing revenue on EGD and colonoscopy claims? Request a free GI coding audit from AffinityCore
Frequently Asked Questions
What is the CPT code for an EGD?
The CPT code for a diagnostic EGD (esophagogastroduodenoscopy) is 43235. Therapeutic EGDs use codes in the 43233–43270 range, such as 43239 for biopsy or 43249 for balloon dilation.
What is the difference between CPT 43235 and 43239?
43235 is a diagnostic EGD with no tissue sampling beyond brushing or washing. 43239 is an EGD with biopsy, billed once however many biopsies are taken. Never report both in the same session.
What is the CPT code for EGD with dilation?
43249 for balloon dilation of the esophagus under 30 mm, 43233 for balloon dilation of 30 mm or more, 43248 for wire-guided bougie (Savary) dilation, and 43245 for gastric or duodenal strictures.
What is the CPT code for endoscopic ultrasound?
43259 for a full upper EUS exam, 43237 for a limited exam, and 43242 or 43238 when fine-needle aspiration or biopsy is performed.
Can an EGD and a colonoscopy be billed on the same day?
Yes. Bill both codes, for example 43239 + 45380. They are different endoscopy families, so both are paid with the standard multiple-procedure reduction. Anesthesia is reported with 00813.
What is the ICD-10-PCS code for EGD?
A diagnostic inpatient EGD is 0DJ08ZZ, inspection of the upper intestinal tract via natural opening, endoscopic. Biopsies and other therapeutic services have their own ICD-10-PCS codes.
