Friday, June 4, 2010

Esophagogastroduodenoscopy EGD CPT CODE List 43239, 43235 and payment amount

EGD - Procedure

Most used CPT code list and description


43235
EGD diagnostic Fee schedule amount $ 310.8

43239 EGD w biopsy , Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple  Fee schedule amount $ 395.61

43244

EGD w banding Fee schedule amount $ 267.01

43245

EGD w dilatation over guided wire Fee schedule amount $ 609.42

43246

EGD w PEG placement Fee schedule amount $ 219.62
43247 EGD w removal of foreign body
43248 EGD w esophageal dilatation over guided wire
43249 EGD w TTS balloon dilatation
43251 EGD w polypectomy snared
43255 EGD w endoclip applied to control bleeding/heater probe auterization
43227 Esophagoscopy w control of bleeding
43256 Esophagoscopy w stent placement 
43241 Esophagoscopy w catheter placement in esophagus


Esophagogastroduodenoscopy (EGD) Codes – (43235 – 43259)

 CPT codes 43235-43259 have been placed in the new EGD subsection. These codes have been revised to describe flexible transoral EGD and include five new codes, revision and renumbering of several existing codes and the deletion of two codes. Additionally, the following qualification to the definition of EGD has been included in the new EGD Guideline language to clarify the appropriate use of modifiers -52 and -53:

To report esophagogastroscopy where the duodenum is deliberately not examined [e.g., judged clinically not pertinent], or because significant situations preclude such exam [e.g., significant gastric retention precludes safe exam of duodenum], append modifier 52 if repeat examination is not planned, or modifier 53 if repeat examination is planned)


Coverage Indications, Limitations, and/or Medical Necessity

    Upper intestinal endoscopy is performed with a lighted, flexible, fiberoptic instrument passed through the cricopharynx. The patient receives conscious sedation. A topical anesthetic is sometimes applied to the posterior pharynx. Direct visualization of the entire esophagus, stomach, and duodenum (to the junction of the second and third portions) can be accomplished easily with modern instruments that are less than 12mm in diameter. Esophagogastroduodenoscopy (EGD) is a technique utilized to examine, obtain samples, and in some instances, to treat pathological conditions.

    Diagnostic observations are made concerning focal benign or malignant lesions, diffuse mucosal changes, luminal obstruction, motility, and extrinsic compression by contiguous structures. A diagnostic EGD allows the examiner to visualize abnormalities detectable by the technique and to photograph, biopsy, and/or remove lesions as appropriate.

    The purpose of the therapeutic EGD is to manage hemorrhage; remove foreign bodies and neoplastic growths; to relieve obstruction due to stricture, malignancy, or other causes through dilatation or the placement of stents; and to assist in the placement of percutaneous gastrostomy tubes.

    EGD(s)will be considered medically reasonable and necessary under the following diagnostic conditions:

    · Patient has upper abdominal distress (e.g., gastroesophageal reflux disease) which persists despite an appropriate trial of symptomatic therapy;

    · Patient has upper abdominal distress associated with a short history of signs and symptoms suggesting significant associated disease or illness (e.g., weight loss, anorexia, vomiting, nonsteroidal anti-inflammatory drug [NSAID] intake, other gastric irritant intake);

    · Patients over the age of 40 who have experienced a significant history of heartburn that returns after a course of symptomatic therapy;

    · Patients who have dysphagia or odynophagia;

    · Patient has persistent, unexplained vomiting;

    · Patient has upper gastrointestinal x-ray findings of:

        any lesion that requires biopsy for diagnosis; or-

        gastric ulcer suspicious of cancer; or

        evidence of stricture or obstruction;


    · To assess acute injury after caustic agent ingestion;

    · When anti-reflux surgery is contemplated; or

    · Patient has gastrointestinal bleeding:

        in most actively bleeding patients; or

        for presumed chronic blood loss and iron deficiency anemia when investigation of large bowel is negative.


    EGD(s) will be considered medically reasonable and necessary for the following therapeutic purposes:

        Treatment of bleeding lesions;

        Removal of foreign bodies;

        Sclerotherapy and/or band ligation for bleeding from esophageal or gastric varices;

        Dilatation of strictures in the upper intestinal tract;

        Removal of selected polypoid lesions;

        Placement of feeding tubes; or

        Palliative therapy of stenosing neoplasms (e.g., laser, stent placement).
        ,

    Gastrointestinal bleeding may be treated with a variety of methods. Direct contact heater probes and hemostatic injections into or around the bleeding vessels are both effective therapy for acute bleeding.

    Foreign body removal from the stomach or esophagus is usually successful with these flexible instruments. The foreign bodies can be retrieved by either of two methods. The first method is to capture the foreign body with a snare device/grasping forceps and pull the item out with the endoscope. The second method is accomplished by piecemeal destruction and pushing the bolus through the esophagus into the stomach.

    Esophageal varices may be injected with a variety of sclerosing solutions. Eradication of varices requires, on the average, five sclerotherapy sessions, with multiple injections given during each session.

    Dilatation of strictures may be accomplished with a balloon placed through the endoscope and inflated using hydrostatic pressure. Bougies are rubber dilators available in various sizes up to approximately 2.0cm. Plastic bougies and other dilating probes are usually passed over a guide wire. This procedure involves placing the guide wire into the stomach through the endoscope. The endoscope is then withdrawn leaving the guide wire in place. The dilating probes and plastic bougies are then passed over the guide wire. After the largest dilator is used, the dilator and guide wire are removed. Esophageal dilation is performed after a definitive diagnosis has been established in patients exhibiting dysphagia. The goal in most cases is a lumenal diameter of 16-17mm which allows passage of solid food. A series of dilators may be passed over the guide wire to reach the goal of therapy.

    Follow-up EGD(s)will be considered medically reasonable and necessary for the following indications:

        Biopsy surveillance of patients with Barrett’s esophagus every 12 to 24 months. However, if dysplasia is present, earlier surveillance intervals of from three to six months may be required;

        Follow-up of gastric ulcers to healing or satisfaction that they are benign;

        Follow-up and treatment of esophageal strictures requiring guidewire dilation;

        Follow-up of duodenal ulcer or other lesions of the upper gastrointestinal tract that have resulted in serious consequences (e.g., hemorrhage);

        Follow-up of patients having a previous gastric polypectomy for adenoma; or

        Follow-up and treatment of patients with esophageal varices or bleeding lesions requiring recurrent therapy (e.g., esophageal varices, gastric varices, angiodysplastic or watermelon stomach lesions, radiation gastritis).

        Follow-up for removal of percutaneous gastrostomy tube (PEG)


    Periodic EGD is NOT usually indicated in the following situations:

        Surveillance of healed, benign disease such as gastric or duodenal ulcer or benign esophageal strictures; or

        Cancer surveillance in patients with pernicious anemia, treated achalasia, or prior gastric resection.



    EGD is generally contraindicated for patients with recent myocardial infarction.

Guide Wire and Dilation

The EGD family includes a code for insertion of guide wire followed by dilation over guide wire. Insertion of guide wire code 43248 has been revised to describe passage of dilator(s) over a guide wire rather than dilation. Codes 43248 and 43249 (dilation codes) should not be reported with codes 43266 and 43270, as these codes (stent, ablation) include dilation.

Endoscopic Ultrasound (EUS)

Endoscopic ultrasound (EUS) examination codes 43237 and 43238 have been revised to describe EUS limited to the esophagus, stomach or duodenum and adjacent structures. Endoscopic ultrasound codes 43242 and 43259 have been revised to include examination of a surgically altered stomach where the jejunum is examined distal to the anastomosis. Clarification language has been included to address the extent of performance of the EUS examination as distinguished from the extent of the endoscopic visualization.

Pseudocyst Drainage

In addition to transmural drainage of pseudocyst as described in the current code 43240, EGD with transmural drainage of pseudocyst has been revised to specify that it includes endoscopic ultrasound, transmural drainage and placement of stent(s) to facilitate drainage, when performed.

Dilation Procedures

Dilation procedure codes have been added, revised and deleted to better describe current practice. EGD code 43249 has been revised to specify transendoscopic balloon dilation of less than 30 mm in diameter. Code 43233 (>30mm balloon, e.g., achalasia) includes fluoroscopic guidance, when used. Code 43245 has been revised  to describe dilation of gastric/duodenal stricture(s) and the guide wire example has been removed from the examples in parentheses. Code 43233 includes moderate sedation, as indicated by the moderate sedation symbol.

Control of Bleeding

The parentheticals for code 43255, EGD with control of bleeding code 43255 have been revised. Code 43255 should not be reported for treatment of esophageal/gastric varices, which are reported with more specific codes 43243 (sclerotherapy) or 43244 (banding). Code 43236, submucosal injection, would also not be reported if injection was part of the control of bleeding procedure.


Balloon Dilation of Esophagus

EGD code 43233 (out of sequence) has been established to report balloon dilation of 30 mm in diameter or larger. This dilation procedure includes fluoroscopic guidance, when used.

Endoscopic Mucosal Resection

Code 43254 has been established to report endoscopic mucosal resection (EMR) with EGD. Code 43254 includes removal of tumor(s), polyp(s) or other lesion(s) by snare technique (43251); directed submucosal injection(s) (43236); and band ligation (43254), so these services are not separately reportable when performed on the same lesion during the same session. Biopsy (43239) performed on the same lesion as EMR is not separately reportable. Code 43254 includes moderate sedation, as indicated by the moderate sedation symbol.

Ultrasound-Guided Injections / Placement of Fiducial Markers

Code 43253 has been established to describe ultrasound-guide d transmural injection of substances (e.g., celiac axis injection) or fiducial markers. This code includes endoscopic ultrasound (EUS) of the esophagus, stomach, and either the duodenum or a surgically-altered stomach where the jejunum is examined distal to the anastomosis. Ablation of Tumors A new code has been established for EGD with ablation (43270). The new code includes pre- and post-dilation and guide wire passage when performed. Separate reporting of pre- or post-dilation or guide wire passage when performing ablation of the same lesion during the same session would not be appropriate. Ablation procedures are reported without a reduced services modifier 52, even if all three components (pre-dilation, post-dilation or guide wire passage) are not performed during the same session.

Placement of Stent

Revised code descriptor language for placement of an endoscopic stent in the esophagus states “pre-and postdilation and guide wire passage, when performed”. Code 43266, EGD with placement of stent is reported without a reduced services modifier 52, even if all three components (pre-dilation, post-dilation, and guide wire passage) are not performed during the same session. Separate reporting of pre-dilation, post-dilation or guide wire passage of the same lesion during the same session would not be appropriate.


GI PROCEDURES

The key to accurately coding endoscopic procedures depends on knowing exactly what the surgeon did and the final destination of the scope.

A “Separate Site”, for definition purposes, can be a separation between lesions of 1 centimeter.

• Esophagogastroduodenoscopy (EGD) Procedures

Code 43239 – Biopsy – most common procedure – also use for CLO test or H.pylori test
Code 43255 – Control of Bleeding – don’t bill unless pt. came in with Bleed of has Post-OP Bleed

• Upper GI Dilations
Code 43248 – Savory Dilation – uses a Guidewire
Code 43450 – Maloney Dilation-Unguided
Code 43249 – Balloon Dilatio


QUESTION: Is there a difference regarding the use of modifiers 52 and 53 with regards to upper and lower endoscopic procedures?

ANSWER: Yes.

X EGD procedures: To report esophagogastroscopy where the duodenum is deliberately not examined (e.g., judged  clinically not pertinent) or because significant situations preclude such exam (e.g., significant gastric retention precludes safe exam of duodenum), append modifier 52, if repeat examination is not planned, or modifier 53, if repeat examination is planned.

• Example: EGD is performed and a tube is placed into the stomach. The duodenum is not examined and there is no plan to perform repeat EGD to examine the duodenum. Report procedure with modifier 52.

• Example: EGD is performed for evaluation of GI bleeding; the stomach is full of blood and the duodenum is not examined. Plan to control bleeding, lavage stomach and repeat upper endoscopy. Report procedure with modifier 53.


Limitations

Colonoscopy is generally not covered for treating the following:

Chronic/stable irritable bowel syndrome (There are unusual exceptions in which colonoscopy may be done once to rule out organic disease.);

Chronic abdominal pain;

Acute limited diarrhea;

Hemorrhoids;

Metastatic adenocarcinoma of unknown primary site in the absence of colonic symptoms when it will not influence management;

Routine follow-up of inflammatory bowel disease (except for cancer surveillance in chronic ulcerative colitis);

Routine examination of the colon in patients about to undergo elective abdominal surgery for non-colonic disease;

Upper gastrointestinal (GI) bleeding or melena with a demonstrated upper GI source;

Bright red rectal bleeding in patient with a convincing anorectal source on sigmoidoscopy and no other symptoms suggestive of a more proximal bleeding source;

Fulminant colitis;

Possible perforated viscus; or

Acute severe diverticulitis.

Coverage Limitations for EGD(s)

  • Distress that is chronic, non-progressive, atypical for known organic disease and is considered functional in origin (there are occasional exceptions in which an endoscopic examination may be done once to rule out organic disease, especially if symptoms are unresponsive to therapy).
  • Uncomplicated heartburn responding to medical therapy.
  • Metastatic adenocarcinoma of unknown primary site when the results will not alter management.
  • X-ray findings of:
    • Asymptomatic or uncomplicated sliding hiatus hernia.
    • Uncomplicated duodenal bulb ulcer that has responded to therapy.
  • Deformed duodenal bulb when symptoms are absent or respond adequately to ulcer therapy.
  • Routine screening of the upper gastrointestinal tract, without current gastrointestinal symptoms, about to undergo elective surgery for non-upper gastrointestinal disease.
  • When lower GI endoscopy reveals the cause of symptoms, abnormal signs or laboratory tests (e.g., colonic neoplasm with iron deficiency anemia). Exceptions can be considered if medical necessity for this procedure can be demonstrated.

GI Procedures Frequently Miscoded

When a GI procedure has to be stopped or is not completed because of problems with the scope, irregular patient anatomy, encountering a tumor, or a poor prep, the ASC should append either a -52 Reduced Procedure or the -74 Discontinued Procedure Modifier to the CPT code for the procedure that was terminated. The choice of modifier would depend on the preference of the payor to whom the claim is being submitted. When the word “Snare” appears in a Colonoscopy OP Report as the technique used to remove a polyp, use a Snare procedure code, rather than a code driven by the temperature. For example, if the OP Report states a polyp was removed by “Cold Snare” or “Hot Snare”, use the 45385 Snare Polypectomy Colonoscopy code.

For either a Colonoscopy or EGD, if the one lesion is biopsied, and a separate lesion is removed during the same case, code both the biopsy of the lesion and the removal of the separate lesion – as long as the lesions are at least one cm. apart. Append a –59 Modifier to the biopsy procedure, if it is Unbundled from the excision procedure.

If an EGD is performed with a biopsy, and then the physician removes the scope and performs an Esophageal Dilation by unguided sound, it should be billed using two CPT codes – CPT code 43239 for the EGD with a biopsy and code 43450 for the Esophageal Dilation.

If an EGD is performed with a biopsy, and then the physician performs an Esophageal Dilation using the scope instrument itself, only the 43239 EGD with Biopsy code is billable. If no Biopsy is performed and the only procedure performed is an Esophageal Dilation using the scope instrument itself, only the 43235 Diagnostic EGD code is billable.

Use code 43243 for an EGD with injection sclerosis of esophageal and/or gastric varices. Use code 45381 for a Colonscopy in which Saline is injected to raise a polyp, ink is injected or Tattooing of a lesion is performed. This code is not usually Unbundled from the Biopsy or Polypectomy codes.

If the physician attempts – but fails – to remove a polyp by one (example, Snare) technique, but is successful at removing the polyp via another technique (such as Hot Biopsy Forceps) only bill the CPT code for the procedure that was successful (45384).

If an EGD with a Polypectomy by Cold Biopsy Forceps is performed, use the 43258 Ablation code – not the 43239 Biopsy code. Use code 45380 for Colonoscopy procedures performed with Biopsies and/or the Removal of all or portions of Polyps using Cold Biopsy Forceps.

Use code 45383 for colon polyps treated by the Ablation technique, where a polyp is removed using the APC, laser, heat probe, or other device to cauterize it or the remnants of a polyp previously removed during a colonoscopy procedure. Use this code also when polyps are Fulgurated.


Colonoscopy procedures performed through Stomas (Ileostomy and Colostomy patients) are coded from section 44388-44397 codes.


GI Procedures Frequently Miscoded

When a GI procedure has to be stopped or is not completed because of problems with the scope, irregular patient anatomy, encountering a tumor, or a poor prep, the ASC should append either a -52 Reduced Procedure or the -74 Discontinued Procedure Modifier to the CPT code for the procedure that was terminated. The choice of modifier would depend on the preference of the payor to whom the claim is being submitted.

When the word “Snare” appears in a Colonoscopy OP Report as the technique used to remove a polyp, use a Snare procedure code, rather than a code driven by the temperature. For example, if the OP Report states a polyp was removed by “Cold Snare” or “Hot Snare”, use the 45385 Snare Polypectomy Colonoscopy code.

For either a Colonoscopy or EGD, if the one lesion is biopsied, and a separate lesion is removed during the same case, code both the biopsy of the lesion and the removal of the separate lesion – as long as the lesions are at least one cm. apart. Append a –59 Modifier to the biopsy procedure, if it is Unbundled from the excision procedure.

If an EGD is performed with a biopsy, and then the physician removes the scope and performs an Esophageal Dilation by unguided sound, it should be billed using two CPT codes – CPT code 43239 for the EGD with a biopsy and code 43450 for the Esophageal Dilation.

If an EGD is performed with a biopsy, and then the physician performs an Esophageal Dilation

using the scope instrument itself, only the 43239 EGD with Biopsy code is billable. If no Biopsy is performed and the only procedure performed is an Esophageal Dilation using the scope instrument itself, only the 43235 Diagnostic EGD code is billable.

Use code 43243 for an EGD with injection sclerosis of esophageal and/or gastric varices.

Use code 45381 for a Colonscopy in which Saline is injected to raise a polyp, ink is injected or Tattooing of a lesion is performed. This code is not usually Unbundled from the Biopsy or Polypectomy codes.

If the physician attempts – but fails – to remove a polyp by one (example, Snare) technique, but is successful at removing the polyp via another technique (such as Hot Biopsy Forceps) only bill the CPT code for the procedure that was successful (45384).

If an EGD with a Polypectomy by Cold Biopsy Forceps is performed, use the 43258 Ablation code – not the 43239 Biopsy code.

Use code 45380 for Colonoscopy procedures performed with Biopsies and/or the Removal of all or portions of Polyps using Cold Biopsy Forceps.

Use code 45383 for colon polyps treated by the Ablation technique, where a polyp is removed using the APC, laser, heat probe, or other device to cauterize it or the remnants of a polyp previously removed during a colonoscopy procedure. Use this code also when polyps are Fulgurated.

Colonoscopy procedures performed through Stomas (Ileostomy and Colostomy patients) are coded from section 44388-44397 codes. 

ICD-10 Codes that Support Medical Necessity
    B25.2 Cytomegaloviral pancreatitis
    B37.81 Candidal esophagitis
    C15.3 Malignant neoplasm of upper third of esophagus
    C15.4 Malignant neoplasm of middle third of esophagus
    C15.5 Malignant neoplasm of lower third of esophagus
    C15.8 Malignant neoplasm of overlapping sites of esophagus
    C15.9 Malignant neoplasm of esophagus, unspecified
    C16.0 Malignant neoplasm of cardia
    C16.1 Malignant neoplasm of fundus of stomach
    C16.2 Malignant neoplasm of body of stomach
    C16.3 Malignant neoplasm of pyloric antrum
    C16.4 Malignant neoplasm of pylorus
    C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
    C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
    C16.8 Malignant neoplasm of overlapping sites of stomach
    C16.9 Malignant neoplasm of stomach, unspecified
    C17.0 Malignant neoplasm of duodenum
    C17.1 Malignant neoplasm of jejunum
    C17.2 Malignant neoplasm of ileum
    C17.3 Meckel's diverticulum, malignant
    C17.8 Malignant neoplasm of overlapping sites of small intestine
    C17.9 Malignant neoplasm of small intestine, unspecified
    C22.0 Liver cell carcinoma
    C22.2 Hepatoblastoma
    C22.3 Angiosarcoma of liver
    C22.4 Other sarcomas of liver
    C22.7 Other specified carcinomas of liver
    C22.8 Malignant neoplasm of liver, primary, unspecified as to type
    C23 Malignant neoplasm of gallbladder
    C24.0 Malignant neoplasm of extrahepatic bile duct
    C24.1 Malignant neoplasm of ampulla of Vater
    C24.8 Malignant neoplasm of overlapping sites of biliary tract
    C24.9 Malignant neoplasm of biliary tract, unspecified
    C25.0 Malignant neoplasm of head of pancreas
    C25.1 Malignant neoplasm of body of pancreas
    C25.2 Malignant neoplasm of tail of pancreas
    C25.3 Malignant neoplasm of pancreatic duct
    C25.4 Malignant neoplasm of endocrine pancreas
    C25.7 Malignant neoplasm of other parts of pancreas
    C25.8 Malignant neoplasm of overlapping sites of pancreas
    C25.9 Malignant neoplasm of pancreas, unspecified
    C26.9 Malignant neoplasm of ill-defined sites within the digestive system
    C46.4 Kaposi's sarcoma of gastrointestinal sites
    C49.A0 Gastrointestinal stromal tumor, unspecified site
    C49.A1 Gastrointestinal stromal tumor of esophagus
    C49.A2 Gastrointestinal stromal tumor of stomach
    C49.A9 Gastrointestinal stromal tumor of other sites
    C78.4 Secondary malignant neoplasm of small intestine
    C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum
    C79.89 Secondary malignant neoplasm of other specified sites
    C79.9 Secondary malignant neoplasm of unspecified site
    C82.50 Diffuse follicle center lymphoma, unspecified site
    C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
    C84.90 Mature T/NK-cell lymphomas, unspecified, unspecified site
    C84.99 Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
    C84.A0 Cutaneous T-cell lymphoma, unspecified, unspecified site
    C84.A9 Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
    C84.Z0 Other mature T/NK-cell lymphomas, unspecified site
    C84.Z9 Other mature T/NK-cell lymphomas, extranodal and solid organ sites
    C85.10 Unspecified B-cell lymphoma, unspecified site
    C85.19 Unspecified B-cell lymphoma, extranodal and solid organ sites
    C85.20 Mediastinal (thymic) large B-cell lymphoma, unspecified site
    C85.29 Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
    C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site
    C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
    C85.90 Non-Hodgkin lymphoma, unspecified, unspecified site
    C85.99 Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites
    C86.4 Blastic NK-cell lymphoma
    D00.1 Carcinoma in situ of esophagus
    D00.2 Carcinoma in situ of stomach
    D01.0 Carcinoma in situ of colon
    D01.1 Carcinoma in situ of rectosigmoid junction
    D01.2 Carcinoma in situ of rectum
    D01.3 Carcinoma in situ of anus and anal canal
    D01.40 Carcinoma in situ of unspecified part of intestine
    D01.49 Carcinoma in situ of other parts of intestine
    D01.5 Carcinoma in situ of liver, gallbladder and bile ducts
    D12.0 Benign neoplasm of cecum
    D12.1 Benign neoplasm of appendix
    D12.2 Benign neoplasm of ascending colon
    D12.3 Benign neoplasm of transverse colon
    D12.4 Benign neoplasm of descending colon
    D12.5 Benign neoplasm of sigmoid colon
    D12.6 Benign neoplasm of colon, unspecified
    D12.7 Benign neoplasm of rectosigmoid junction
    D12.8 Benign neoplasm of rectum
    D12.9 Benign neoplasm of anus and anal canal
    D13.0 Benign neoplasm of esophagus
    D13.1 Benign neoplasm of stomach
    D13.2 Benign neoplasm of duodenum
    D13.30 Benign neoplasm of unspecified part of small intestine
    D13.39 Benign neoplasm of other parts of small intestine
    D13.4 Benign neoplasm of liver
    D13.5 Benign neoplasm of extrahepatic bile ducts
    D13.6 Benign neoplasm of pancreas
    D13.7 Benign neoplasm of endocrine pancreas
    D13.9 Benign neoplasm of ill-defined sites within the digestive system
    D17.5 Benign lipomatous neoplasm of intra-abdominal organs
    D17.71 Benign lipomatous neoplasm of kidney
    D17.9 Benign lipomatous neoplasm, unspecified
    D18.03 Hemangioma of intra-abdominal structures
    D19.1 Benign neoplasm of mesothelial tissue of peritoneum
    D20.0 Benign neoplasm of soft tissue of retroperitoneum
    D20.1 Benign neoplasm of soft tissue of peritoneum
    D37.1 Neoplasm of uncertain behavior of stomach
    D37.2 Neoplasm of uncertain behavior of small intestine
    D37.3 Neoplasm of uncertain behavior of appendix
    D37.4 Neoplasm of uncertain behavior of colon
    D37.5 Neoplasm of uncertain behavior of rectum
    D37.6 Neoplasm of uncertain behavior of liver, gallbladder and bile ducts
    D48.3 Neoplasm of uncertain behavior of retroperitoneum
    D48.4 Neoplasm of uncertain behavior of peritoneum
    D49.0 Neoplasm of unspecified behavior of digestive system
    D50.0 Iron deficiency anemia secondary to blood loss (chronic)
    D50.1 Sideropenic dysphagia
    D50.8 Other iron deficiency anemias
    D50.9 Iron deficiency anemia, unspecified
    D62 Acute posthemorrhagic anemia
    E16.4 Increased secretion of gastrin
    E16.9 Disorder of pancreatic internal secretion, unspecified
    E41 Nutritional marasmus
    E44.0 Moderate protein-calorie malnutrition
    E44.1 Mild protein-calorie malnutrition
    E45 Retarded development following protein-calorie malnutrition
    E46 Unspecified protein-calorie malnutrition
    E64.0 Sequelae of protein-calorie malnutrition
    F44.4 Conversion disorder with motor symptom or deficit
    F44.5 Conversion disorder with seizures or convulsions
    F44.6 Conversion disorder with sensory symptom or deficit
    F44.7 Conversion disorder with mixed symptom presentation
    F45.8 Other somatoform disorders
    F50.00 Anorexia nervosa, unspecified
    F50.01 Anorexia nervosa, restricting type
    F50.02 Anorexia nervosa, binge eating/purging type
    F50.2 Bulimia nervosa
    F50.81 Binge eating disorder
    F50.89 Other specified eating disorder
    F50.9 Eating disorder, unspecified
    F98.21 Rumination disorder of infancy
    F98.3 Pica of infancy and childhood
    I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
    I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
    I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
    I69.391 Dysphagia following cerebral infarction
    I69.891 Dysphagia following other cerebrovascular disease
    I69.991 Dysphagia following unspecified cerebrovascular disease
    I77.2 Rupture of artery
    I78.0 Hereditary hemorrhagic telangiectasia
    I85.00 Esophageal varices without bleeding
    I85.01 Esophageal varices with bleeding
    I85.10 Secondary esophageal varices without bleeding
    I85.11 Secondary esophageal varices with bleeding
    J69.0 Pneumonitis due to inhalation of food and vomit
    J86.0 Pyothorax with fistula
    K20.0 Eosinophilic esophagitis
    K20.8 Other esophagitis
    K20.9 Esophagitis, unspecified
    K21.0 Gastro-esophageal reflux disease with esophagitis
    K21.9 Gastro-esophageal reflux disease without esophagitis
    K22.0 Achalasia of cardia
    K22.10 Ulcer of esophagus without bleeding
    K22.11 Ulcer of esophagus with bleeding
    K22.2 Esophageal obstruction
    K22.3 Perforation of esophagus
    K22.4 Dyskinesia of esophagus
    K22.5 Diverticulum of esophagus, acquired
    K22.6 Gastro-esophageal laceration-hemorrhage syndrome
    K22.70 Barrett's esophagus without dysplasia
    K22.710 Barrett's esophagus with low grade dysplasia
    K22.711 Barrett's esophagus with high grade dysplasia
    K22.719 Barrett's esophagus with dysplasia, unspecified
    K22.8 Other specified diseases of esophagus
    K23 Disorders of esophagus in diseases classified elsewhere
    K25.0 Acute gastric ulcer with hemorrhage
    K25.1 Acute gastric ulcer with perforation
    K25.2 Acute gastric ulcer with both hemorrhage and perforation
    K25.3 Acute gastric ulcer without hemorrhage or perforation
    K25.4 Chronic or unspecified gastric ulcer with hemorrhage
    K25.5 Chronic or unspecified gastric ulcer with perforation
    K25.6 Chronic or unspecified gastric ulcer with both hemorrhage and perforation
    K25.7 Chronic gastric ulcer without hemorrhage or perforation

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