Summary & Overview
CPT 43247: EGD with Foreign Body Removal
CPT code 43247 denotes an esophagogastroduodenoscopy (EGD) with identification and removal of foreign bodies from the upper gastrointestinal tract. This procedure is clinically important for managing ingested or obstructing objects that threaten airway integrity, cause obstruction, or risk perforation. It is commonly performed in acute and elective settings and has implications for patient safety, resource utilization, and facility-level care pathways nationwide.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical scope and typical sites of service, practical considerations for billing and documentation, commonly used modifiers, and how this service aligns with related endoscopic procedures. The publication summarizes benchmarking and reimbursement context where available, highlights policy updates relevant to upper endoscopy services, and clarifies clinical indications that commonly support use of this code.
Intended for clinicians, coding staff, and policy analysts, the content provides the clinical and administrative context needed to interpret use of CPT code 43247 at a national level. Data not available in the input is noted explicitly where applicable.
Billing Code Overview
CPT code 43247 describes an esophagogastroduodenoscopy (EGD) using a flexible esophagogastroduodenoscope inserted through the mouth to examine the esophagus, stomach, and duodenum and to identify and remove foreign bodies. The procedure involves a tubular instrument with a light source and camera to visualize the upper gastrointestinal tract and perform endoscopic extraction of obstructing or ingested objects.
Service Type: Diagnostic and therapeutic upper endoscopy (EGD) with foreign body removal
Typical Site of Service: Hospital outpatient endoscopy unit, ambulatory surgical center, or emergency department
Clinical & Coding Specifications
Clinical Context
A 3-year-old child presents to the emergency department after swallowing a coin. The child has drooling, intermittent vomiting, and refusal to eat. Plain radiographs confirm a radiopaque foreign body lodged in the proximal esophagus. The gastroenterology team is consulted. After pre-procedure consent and anesthetic assessment, the patient undergoes an urgent esophagogastroduodenoscopy (EGD) with flexible esophagogastroduodenoscope under general anesthesia. The provider inspects the esophagus, stomach, and duodenum, locates the foreign body in the upper esophagus, and removes it using endoscopic forceps. Post-procedure, the patient is observed in recovery for airway stability and discharged home with instructions and follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical difficulty substantially exceeds typical EGD with foreign body removal. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned. |