Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy. Please refer to the LCD for reasonable and necessary requirements. Coding Guidance Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. Documentation Requirements All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. 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 Esophagogastroduodenoscopy (EGD). Also, the results of the EGD must be included in the patient’s medical record.