Upper Endoscopy (EGD, With Biopsy)

What it is

Esophagogastroduodenoscopy — EGD, or simply upper endoscopy — is the mirror image of a colonoscopy at the other end of the digestive tract. A flexible scope with a camera goes in through the mouth and down the esophagus into the stomach and the duodenum, the first part of the small intestine. This code describes an exam in which the doctor also took one or more small tissue samples through the scope for a pathologist to examine. It is a diagnostic procedure, not a surgery: nothing is cut open, and the whole thing typically lasts only a few minutes once it is underway.

Why it is done

• To find the cause of heartburn that hasn't improved, trouble or pain on swallowing, ongoing nausea, or upper abdominal pain
• To look for and sample ulcers, inflammation, and changes to the lining of the esophagus
• To diagnose celiac disease, which is confirmed by sampling the lining of the small intestine rather than by the view alone
• To investigate bleeding from the upper digestive tract, or unexplained anemia that may be coming from there

What to expect

Patients fast beforehand so the stomach is empty. Most people are given sedation through an IV and a numbing spray for the throat, and have little or no memory of the procedure. Afterward it is normal to feel bloated from the air used to open up the stomach for viewing, and to have a mildly sore throat for a day. Eating and drinking wait until the numbing has worn off and swallowing is normal again. As with any sedation, someone else drives home. Biopsy results come back from the lab days later, not the same day.

Questions worth asking

• Is the sedation billed by a separate anesthesia group, and is that group in network here? This is one of the most common surprise lines on an endoscopy bill.
• Which pathology lab reads the biopsies, and how many specimens are likely to be sent? Pathology is often billed per specimen.
• Hospital outpatient department or freestanding endoscopy center? The facility fee usually differs substantially between the two.
• If the doctor also treats something during the same session — stretching a narrowed area, for instance — does that change the code and the price?