Are you confident that your gastroenterology practice is using the right CPT codes for billing? With the growing number of gastrointestinal conditions and the complexity of procedures, maintaining accurate coding has never been more important.
The demand for gastroenterology services continues to increase as more people seek treatment for digestive issues, which means billing and coding professionals face a greater challenge than ever.
Inaccurate coding can lead to claim denials, delayed payments, and potential compliance issues. In this guide, we’ll walk you through the most commonly used CPT codes in gastroenterology for 2025, covering everything from diagnostic procedures and imaging to non-surgical interventions.
What Are Gastroenterology CPT Codes?
CPT (Current Procedural Terminology) codes are essential for documenting and billing medical procedures. In gastroenterology, these codes are used to accurately report procedures related to the diagnosis, treatment, and management of gastrointestinal (GI) conditions.
These codes not only ensure proper reimbursement for services rendered but also help standardize the process for medical documentation, improving the overall quality of care. Accurate CPT coding is crucial for gastroenterology practices, as improper billing can result in delayed reimbursements, claim denials, or compliance issues.
Most Common Gastroenterology CPT Codes
The following list highlights some of the most commonly used CPT codes in gastroenterology. These codes cover diagnostic procedures, imaging techniques, non-surgical interventions, and more. Understanding them will help ensure your practice stays compliant and efficient in billing.
1. Gastroenterology CPT Codes for Diagnostic Procedures
CPT Code 43200 – Esophagoscopy with Flexible Brush
This code is used when a flexible endoscope is passed through the mouth to examine the esophagus and collect tissue samples via a brush for pathological analysis.
CPT Code 91010 – Esophagus Muscle Pressure & Movement Analysis
Used to assess esophageal motility, this test measures muscle pressure and movement in the esophagus. It’s commonly performed to diagnose conditions like gastroesophageal reflux disease (GERD).
CPT Code 91022 – Stomach Motility Analysis
This code is for testing stomach motility by measuring muscle pressure and movement in the stomach and duodenum, helping to identify abnormalities in muscle function that could lead to digestive issues.
CPT Code 91034 – Gastroesophageal Reflux Test (24-hour pH Monitoring)
A diagnostic test to assess acid reflux, where a catheter is inserted through the nose to monitor esophageal pH levels over 24 hours, helping to diagnose GERD.
CPT Code 91040 – Esophageal Balloon Dilation
This code covers the use of a balloon during endoscopy to stretch a narrowed section of the esophagus. It’s typically used to treat strictures caused by GERD or other esophageal conditions.
CPT Code 91065 – Breath Test
Used for diagnosing gastric bacterial overgrowth, lactose intolerance, and other digestive disorders, this non-invasive test measures hydrogen and methane levels in a patient’s breath after fasting for 8-12 hours.
2. Gastroenterology CPT Codes for Imaging Procedures
CPT Code 91110 – Capsule Endoscopy
This minimally invasive procedure involves swallowing a capsule with a camera that captures images of the gastrointestinal tract from the esophagus to the ileum, allowing for detailed examination of hard-to-reach areas.
CPT Code 91122 – Anorectal Manometry
A diagnostic test that measures the function of the rectum and anal sphincter, often used to investigate issues like constipation or fecal incontinence.
3. Gastroenterology CPT Codes for Non-Surgical Procedures
CPT Code 43215 – Esophagoscopy with Removal of Foreign Body
This code is used when a flexible endoscope is employed to remove a foreign object, typically food, from the esophagus. It’s common in emergency settings.
CPT Code 43216 – Esophagoscopy with Removal of Tumor
Used for the removal of tumors or abnormal growths from the esophagus, often through a flexible endoscope that allows for biopsy or removal of lesions.
Gastroenterology CPT Codes for Endoscopy Procedures
Upper GI Procedures:
43180–43233 – Esophagoscopy Procedures
This range of codes covers various esophagoscopy procedures, including diagnostic examinations and therapeutic interventions like biopsies, dilation, and foreign body removal. Specific codes include:
- 43200 – Diagnostic esophagoscopy with brushing or washing.
- 43201 – Esophagoscopy with directed submucosal injections.
- 43202 – Esophagoscopy with biopsy, single or multiple.
- 43205 – Esophagoscopy with band ligation of esophageal varices.
- 43215 – Esophagoscopy with removal of foreign body.
43235–43259 – Esophagogastroduodenoscopy (EGD) Procedures
This group of codes refers to the various diagnostic and therapeutic procedures that involve examining the esophagus, stomach, and duodenum. For example:
- 43235 – Diagnostic EGD, including specimen collection.
- 43241 – EGD with insertion of an intraluminal tube or catheter.
43260–43278 – Endoscopic Retrograde Cholangiopancreatography (ERCP) Procedures
ERCP is a procedure used to examine the bile ducts and pancreatic duct. Key codes include:
- 43260 – Diagnostic ERCP.
- 43262 – ERCP with biopsy of the bile duct.
Gastro Jejunostomy & Related Codes:
CPT Code 43820 – Gastro Jejunostomy
This code refers to the surgical creation of an opening between the stomach and jejunum, often used for feeding or bypass procedures.
Gastroenterology CPT Codes for Colonoscopy and Lower GI Procedures
45378–45398 – Colonoscopy Procedures
These codes cover a wide range of colonoscopy procedures, including diagnostic and therapeutic interventions like biopsies, removal of foreign bodies, and tumor ablation. Examples include:
- 45378 – Colonoscopy with diagnostic evaluation and specimen collection.
- 45380 – Colonoscopy with biopsy, single or multiple.
- 45389 – Colonoscopy with stent placement.
44401–44404 – Colonoscopy Through Stoma
Used when performing colonoscopy through a stoma, these codes apply to diagnostic and therapeutic procedures such as tumor removal and bleeding control.
Esophagogastroduodenoscopy (EGD) & Other Upper GI Procedures
43235 – Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including specimen collection
This is used for diagnostic procedures involving the esophagus, stomach, and duodenum, where tissue samples are taken to examine potential conditions such as ulcers or cancer.
43236 – Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance
This code is used when an EGD includes submucosal injections, which may be used for treatments like sclerotherapy or local anesthesia during the procedure.
43239 – Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
This code covers diagnostic EGDs where the doctor takes one or more biopsies from the esophagus, stomach, or duodenum to investigate potential conditions such as cancer or infections.
43241 – Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter
This involves the insertion of a tube or catheter during the EGD procedure, often used for feeding, drainage, or medication delivery.
43243 – Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices
Like esophageal varices sclerosis, this code is used for the treatment of varices found in the stomach and esophagus by injecting a sclerosing agent.
43250 – Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
When using hot biopsy forceps to remove tumors, polyps, or other lesions during EGD, this code is used.
43266 – Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent
This code reflects the insertion of a stent in the upper gastrointestinal tract, typically done to maintain patency in cases of obstruction.
43270 – Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s)
Covers procedures where lesions are destroyed via ablation, including pre- and post-dilation, and guide wire placement when performed.
Colonoscopy & Lower GI Procedures
- 45378 – Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed
This code is for colonoscopy procedures performed for diagnostic purposes, including tissue collection for biopsy. - 45379 – Colonoscopy, flexible; with removal of foreign body
Used when foreign objects, such as ingested items, are removed from the colon via colonoscopy. - 45384 – Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
This code applies when tumors, polyps, or lesions are removed using hot biopsy forceps during a colonoscopy. - 45388 – Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s)
This covers the destruction of tumors or polyps during colonoscopy, including the necessary dilation and guide wire placement. - 45398 – Colonoscopy, flexible; with band ligation(s)
Used for colonoscopy procedures that include banding of hemorrhoids or varices, typically for controlling bleeding.
Conclusion
The codes mentioned in this guide cover a wide range of gastroenterology procedures, from diagnostic tests and imaging techniques to non-surgical and endoscopic interventions. By staying up-to-date on these common CPT codes, gastroenterology practices can improve efficiency, reduce errors, and maintain compliance with billing requirements.
For any practice or coding professional, keeping track of CPT codes—whether you’re dealing with diagnostic procedures like esophagoscopy, advanced treatments such as ERCP, or routine procedures like colonoscopy—is crucial to ensuring that every service rendered is appropriately documented and reimbursed.
