Upper Endoscopy (EGD, diagnostic)

What it is

X-rays and blood tests can suggest a problem in the upper digestive tract, but they cannot show what the lining actually looks like. An upper endoscopy can. A gastroenterologist passes a flexible tube carrying a light and a camera through the mouth, down the esophagus, through the stomach and into the duodenum, watching the surface on a monitor the whole way. The full name — esophagogastroduodenoscopy, shortened to EGD — is just a list of the three regions it reaches. This particular code covers the examination alone. If the doctor takes a tissue sample, removes something, stops a bleeding vessel, or stretches a narrowed segment, the visit is coded differently and costs more.

Why it is done

• To find the cause of swallowing difficulty, persistent heartburn, upper abdominal pain, nausea, or unexplained weight loss when the story alone does not settle it
• To look for ulcers, inflammation, or tumors in the stomach or esophagus
• To check for enlarged veins in the esophagus in people with liver disease
• To follow a lining abnormality that was found earlier and is being watched over time

What to expect

The stomach has to be empty, so eating and drinking stop for several hours beforehand. In the room, sedation is given through an IV, and sometimes the throat is numbed with a spray or gargle as well. Most people have little or no memory of the exam itself. The scope is in and out in roughly ten to twenty minutes. Afterward there is an hour or so in recovery while the sedation wears off, a sore throat or bloated feeling for a while, and no driving for the rest of the day — someone else has to take you home. If nothing was sampled, the doctor can often describe what was seen before you leave.

Questions worth asking

• If a biopsy or a treatment turns out to be needed once the doctor is looking, the code changes mid-procedure. What does that do to the price I was quoted?
• Who is providing the sedation — the endoscopy team, or a separate anesthesia group that bills on its own?
• Is this being done in a hospital endoscopy unit or a freestanding ambulatory surgery center? The facility charge is often the largest line on the bill and differs sharply between the two.
• Am I being scheduled for an endoscopy and a colonoscopy on the same day, and if so, how are the two facility charges combined?