43247

🧬CPT 43247 — EGD with Removal of Foreign Body(s)

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📋 Quick Reference

Field	Detail
CPT Code	43247
Full Descriptor	Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)
Short Descriptor	EGD w/ removal of foreign body(s)
Category	Upper GI Endoscopy — Therapeutic
Specialty	Gastroenterology · General Surgery · Emergency Medicine · Otolaryngology · Pediatric Surgery
Global Period	000 — Zero Days
wRVU (Work)	~2.83 CMS PFS 2026 — verify against current CMS RVU download file
Assistant Payable	❌ No
Bilateral Concept	❌ Not applicable
Moderate Sedation	✅ Bundled — do not separately report 99152-99153
Multiple Procedure Reduction	✅ Yes — 50% reduction applies when billed with additional endoscopic procedures same session
Facility / Non-Facility	Both applicable — RVU totals differ per CMS PFS
Multiple Foreign Bodies, Same Session	Single unit of 43247 regardless of number of objects removed per session
Emergent Context	✅ Frequently performed emergently; no separate emergency modifier required for the CPT code itself

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🔬 Procedure Description

CPT 43247 describes a flexible, transoral esophagogastroduodenoscopy (EGD) during which one or more foreign bodies are identified and removed from the esophagus, stomach, and/or duodenum/proximal jejunum using endoscopic retrieval instruments or techniques.

What Qualifies as a Foreign Body Under 43247

The term “foreign body” encompasses a broad clinical spectrum:

• Ingested non-food objects: Coins, button batteries, disc batteries, safety pins, fish bones, chicken bones, toothpicks, dentures or dental appliances, jewelry, magnets, toy parts, sharp objects (razors, needles, tacks)
• Food bolus impaction: Meat impaction, bread impaction, hot dog impaction, large pill/capsule impaction — food impaction is the most common indication in adults
• Iatrogenic or indwelling foreign bodies: Migrated stents, displaced feeding tube components, lost or migrated capsule endoscopy devices, displaced suture material, migrated clips
• Intentional ingestion: Objects swallowed intentionally (body packing, psychiatric ingestion) — note: narcotics-filled packets (body packing) are a contraindication to endoscopic removal due to rupture risk

Clinical Urgency Stratification

⚠️ Coding and Documentation Note: The urgency level of the procedure (emergent, urgent, or elective) does not change the CPT code selection; 43247 is used across all urgency levels. However, urgency level affects payer documentation requirements, facility-level coding decisions (e.g., revenue codes), and clinical risk stratification. The following stratification is per ASGE guidelines and is clinically important for timing and documentation: ^{ASGE Guidelines on Management of Ingested Foreign Bodies 2023}

Urgency	Timeframe	Foreign Body Types
Emergent (< 2 hours)	Immediate	Button/disc batteries (esophageal), sharp-pointed objects in esophagus, complete esophageal obstruction with inability to manage secretions, signs of airway compromise
Urgent (< 24 hours)	Same day	Non-button battery disc batteries, magnets, esophageal food impaction without complete obstruction, sharp objects in stomach not yet passed pylorus, high-grade partial esophageal obstruction
Non-Urgent / Elective (< 72 hours)	Within days	Blunt objects in stomach (if < 2.5 cm width/< 6 cm length in adults), food impaction with partial obstruction, coins/blunt objects in esophagus without distress

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Procedural Sequence — Step by Step

1. Patient Assessment & Preparation — Airway assessment is paramount, particularly for esophageal foreign bodies or when aspiration risk is present. For button battery ingestion or sharp esophageal objects, plain radiographs (AP and lateral neck/chest/abdomen) are obtained pre-procedure to localize the object. IV access, monitoring, and moderate sedation or general anesthesia (particularly in pediatric patients or for proximal esophageal foreign bodies) are established.

2. Scope Introduction & Survey — A flexible video endoscope is passed transorally. The endoscopist surveys the oropharynx, hypopharynx, and upper esophageal sphincter as the scope is advanced. A full diagnostic evaluation of the accessible upper GI tract is performed in addition to the therapeutic foreign body removal — this component is bundled and not separately reportable.

3. Foreign Body Localization — The foreign body is identified by direct endoscopic visualization. Assessment includes:

   • Type, size, shape, and orientation of the object
   • Location within the GI tract (proximal/mid/distal esophagus, GEJ, fundus, antrum, pylorus, duodenum)
   • Presence of surrounding mucosal injury (erosion, ulceration, laceration, necrosis — particularly important for button batteries)
   • Evidence of perforation or transmural involvement (requires surgical consultation before proceeding)

4. Retrieval Device Selection — The retrieval tool is selected based on object characteristics:

   Retrieval Tool	Best Used For
   Rat-tooth or alligator forceps	Soft objects (food bolus fragments), meat impaction, flat objects
   Retrieval net / Roth Net	Food bolus en bloc removal, soft or irregular objects, multiple small fragments
   Polypectomy snare (loop snare)	Elongated objects (hot dogs, sausage-type food, bones), objects that can be lassoed
   Tripod/tripwire grasping forceps	Smooth, round objects (coins, buttons, hard candies)
   Magnetic retrieval probe	Metallic ferrous objects
   Basket (Dormia-type)	Small round objects, coins, balls
   Overtube	Protects the esophageal and pharyngeal mucosa during repeated passages or when removing sharp objects; may require separate passage

5. Retrieval Technique — The endoscopist engages the foreign body with the selected retrieval device, secures it, and withdraws it through the esophagus and oropharynx either with the endoscope in tandem or through an overtube. For large food bolus impactions, the push technique (advancing the bolus into the stomach rather than pulling it proximally through the esophagus) may be used when there is no perforation risk and the GEJ is patent, though this technique remains controversial and payer-specific documentation may matter.

6. Post-Retrieval Endoscopic Assessment — After removal, the endoscope is re-advanced to assess for:

   • Mucosal injury at the impaction/lodgment site (erosion, ulceration, laceration, perforation risk)
   • Button battery-specific assessment: Circumferential mucosal necrosis, liquefaction, transmural involvement — these injuries can progress rapidly even after battery removal
   • Identification of underlying pathology predisposing to impaction (esophageal stricture, eosinophilic esophagitis, Schatzki ring, web, hiatal hernia, dysmotility)
   • Additional foreign bodies (particularly relevant in psychiatric ingestions or pediatric patients where multiple objects may have been swallowed)

7. Operative Report Documentation Essentials — The following must be documented for compliant coding and medical necessity:

   • Indication and clinical presentation (symptoms, timeline of ingestion if known)
   • Pre-procedure imaging findings (object location, type)
   • Endoscopic findings: object type, size, location, orientation
   • Retrieval technique and instruments used
   • Completeness of removal (entire object vs. fragments)
   • Post-retrieval mucosal assessment
   • Presence/absence of perforation, significant hemorrhage
   • Whether underlying pathology was identified (e.g., stricture, EoE)
   • Any complications and their management

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✅ Includes (Bundled Components)

The following services are inherent to 43247 and must not be separately reported:

• Full diagnostic endoscopic examination of the esophagus, stomach, and duodenum/proximal jejunum — performed as part of the same session
• Removal of one or more foreign bodies during the same endoscopic session — 43247 is reported once regardless of the number of objects removed
• Use of one or more retrieval devices during the same session (forceps, net, snare, basket, magnet probe)
• Moderate sedation administered by the performing endoscopist during the procedure
• Post-retrieval endoscopic mucosal assessment of the same session
• Fluoroscopic guidance incidentally used during the session — payer-specific; verify MAC LCD before billing separately
• Standard photographic documentation and procedural record

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❌ Excludes / Mutually Exclusive Codes

Code	Description	Reason Excluded
43235	Diagnostic EGD	Bundled — diagnostic component is inherent to all therapeutic EGD codes per NCCI
43251	EGD with removal of tumor(s)/polyp(s) by snare	Snare removal of polyp or tumor tissue — distinct from snare removal of foreign body; do not substitute 43251 for foreign body removal
43255	EGD with control of bleeding, any method	When hemorrhage control is the primary procedure — if bleeding is incidental and managed during foreign body removal, 43255 is bundled; if significant, separate hemorrhage control is independently medically necessary; NCCI edits apply
99152 / 99153	Moderate sedation services	Bundled; separately billable only when performed by an independent, non-participating provider
76000	Fluoroscopy	Generally bundled — confirm with payer-specific policy and MAC LCD
43460	Esophagogastric tamponade with balloon	Not applicable in combination — distinct emergency procedure for variceal hemorrhage
43450 / 43453	Esophageal dilation — blind or wire-guided	If an underlying stricture is identified and dilated in the same session as foreign body removal, NCCI edits apply; modifier 59/XU with documentation may support separate billing; verify current NCCI tables
43248	EGD with guide wire insertion and dilation	See above — NCCI bundling when dilation performed same session to address underlying stricture causing the impaction; modifier 59/XU and documentation may apply

💡 Important Nuance — Underlying Pathology Identified at Same Session: It is not uncommon to identify an underlying esophageal stricture, Schatzki ring, or eosinophilic esophagitis as the predisposing cause of a food bolus impaction. If the endoscopist also performs dilation of the underlying stricture during the same session (after removing the food bolus), the additional dilation code (e.g., 43248 or 43249) may be separately reportable with modifier 59 or XU and clear operative documentation that the dilation was a distinct, separately medically necessary procedure — not simply part of the food bolus removal itself. NCCI edits apply; always verify current edits before billing both codes. ^{CMS NCCI Policy Manual v32}

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🌳 Code Tree — EGD Family (Foreign Body / Retrieval Context)

43235 ─── Diagnostic EGD (BASE CODE — diagnostic component bundled into all therapeutic EGDs)
│
│  ── Therapeutic EGD — Object/Material Removal ──
│
├── 43247 ─── EGD with removal of foreign body(s)                     ◀ THIS CODE
│             · Ingested objects: coins, batteries, bones, meat bolus
│             · Any retrieval technique (net, forceps, snare, basket)
│             · One unit per session regardless of # of objects
│
├── 43250 ─── EGD with removal of tumor/polyp(s) by hot biopsy forceps
│             · Tissue pathology — not foreign material
│
├── 43251 ─── EGD with removal of tumor/polyp(s) by snare technique
│             · Polypectomy — do not use for foreign body snare retrieval
│
│  ── Related EGD Dilation (Often Co-Occurring with Food Impaction) ──
│
├── 43248 ─── EGD with guide wire insertion + dilation over guide wire
│             · May be performed after food bolus removal if stricture identified
│             · NCCI edits apply — modifier 59/XU with documentation
│
├── 43249 ─── EGD with balloon dilation of esophagus (< 30 mm)
│             · TTS balloon — alternative dilation technique post-removal
│             · NCCI edits apply
│
│  ── Related Non-Endoscopic Foreign Body Removal ──
│
├── 43020 ─── Esophagotomy — cervical approach, removal of foreign body
│             · Surgical open approach — used when endoscopic removal fails
│             · Not an endoscopic procedure
│
├── 43045 ─── Esophagotomy — thoracic approach, removal of foreign body
│             · Open thoracic surgical approach
│
│  ── EGD Hemorrhage Control (May Be Needed Post-Retrieval) ──
│
└── 43255 ─── EGD with control of bleeding, any method
              · If significant hemorrhage from foreign body site requires dedicated endoscopic hemostasis
              · NCCI edits apply when same session as 43247 — modifier/documentation required

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🏷️ Associated ICD-10-CM Codes

Primary Diagnosis — Foreign Bodies by Location (T18 Series)

💡 ICD-10-CM Coding Guidance — T18 Series: The T18 category covers foreign bodies in the alimentary tract. These are external cause codes that also serve as principal/primary diagnosis codes in the context of foreign body ingestion. The 7th character extension is required: A = initial encounter, D = subsequent encounter, S = sequela. Most endoscopic removals are initial encounters → use A.

ICD-10-CM	Description	HCC (v28)	Notes
T18.0XXA	Foreign body in mouth, initial encounter	❌ No HCC	Oropharyngeal — often managed without endoscopy
T18.100A	Unspecified foreign body in esophagus causing other injury, initial encounter	❌ No HCC	Esophageal FB — non-food object; no compression of trachea
T18.108A	Other foreign body in esophagus causing other injury, initial encounter	❌ No HCC	Coins, batteries, bones — esophageal lodgment
T18.110A	Unspecified foreign body in esophagus causing compression of trachea, initial encounter	❌ No HCC	Esophageal FB with airway compromise — critical distinction; document tracheal compression
T18.118A	Other foreign body in esophagus causing compression of trachea, initial encounter	❌ No HCC	Specific object + tracheal compression
T18.120A	Unspecified foreign body in esophagus causing other injury, initial encounter	❌ No HCC	Esophageal mucosal injury from FB
T18.128A	Other foreign body in esophagus causing other injury, initial encounter	❌ No HCC	Specific object causing esophageal injury
T18.190A	Unspecified foreign body in other part of esophagus, initial encounter	❌ No HCC	FB in esophagus, location not further specified
T18.198A	Other foreign body in other part of esophagus, initial encounter	❌ No HCC
T18.2XXA	Foreign body in stomach, initial encounter	❌ No HCC	Gastric FB — reached the stomach, not passed
T18.3XXA	Foreign body in small intestine, initial encounter	❌ No HCC	Duodenal/proximal jejunal FB accessible via EGD
T18.4XXA	Foreign body in colon, initial encounter	❌ No HCC	Colonic — requires colonoscopy; not EGD
T18.5XXA	Foreign body in anus and rectum, initial encounter	❌ No HCC	Lower GI — requires flexible sigmoidoscopy/colonoscopy or surgical approach
T18.8XXA	Foreign body in other parts of alimentary tract, initial encounter	❌ No HCC	Non-specific or multilevel involvement
T18.9XXA	Foreign body of alimentary tract, part unspecified, initial encounter	❌ No HCC	Use only when no specific location documented

Food Bolus Impaction — Specific Codes

ICD-10-CM	Description	HCC (v28)	Notes
T18.120A	Foreign body in esophagus causing other injury, initial encounter	❌ No HCC	Food bolus impaction is coded here when esophageal and causing injury/obstruction; food is a “foreign body” in ICD-10-CM context
K22.2	Esophageal obstruction	❌ No HCC	Code additionally when food bolus results in complete esophageal obstruction; may be used as primary or secondary depending on clinical context

Button Battery / Disc Battery — High-Risk Specific Coding

ICD-10-CM	Description	HCC (v28)	Notes
T18.108A	Other foreign body in esophagus causing other injury, initial encounter	❌ No HCC	Button battery in esophagus — code the T18 category; add external cause (W44.xXXA) for battery ingestion
W44.A0XA	Battery, unspecified, entering through orifice, initial encounter	❌ No HCC	External cause code for battery ingestion — add as secondary code
W44.A1XA	Button battery entering through orifice, initial encounter	❌ No HCC	Preferred specificity — document “button battery” vs. generic battery

⚠️ Button Battery Critical Alert: Esophageal button battery ingestion is a true endoscopic emergency (< 2 hours to removal). Alkaline leakage causes liquefactive necrosis that can extend transmurally within 2 hours, resulting in esophageal perforation, tracheoesophageal fistula, and aortoesophageal fistula. Injury continues after battery removal — post-retrieval endoscopic surveillance is mandatory. The operative documentation, ICD-10-CM codes (T18.108A + W44.A1XA), and post-procedural findings must all clearly reflect the clinical severity. Aortoesophageal fistula, if it develops, is a catastrophic complication with near-100% mortality without surgical intervention.

Underlying Pathology Predisposing to Impaction

ICD-10-CM	Description	HCC (v28)	Notes
K22.2	Esophageal obstruction / stricture	❌ No HCC	Document as additional code when stricture is found and treated
K20.00	Eosinophilic esophagitis without bleeding	❌ No HCC	Most common underlying cause of food impaction in young adults; always biopsy to confirm EoE at time of EGD if not previously diagnosed
K20.01	Eosinophilic esophagitis with bleeding	❌ No HCC	Active hemorrhage in EoE context
K21.00	GERD with esophagitis without bleeding	❌ No HCC	Peptic stricture predisposing to food impaction
K21.9	GERD without esophagitis	❌ No HCC
K22.4	Dyskinesia of esophagus	❌ No HCC	Motility disorder (achalasia, spasm) causing functional impaction
K22.0	Achalasia of cardia	❌ No HCC	Functional obstruction — food accumulation/impaction
K31.1	Adult hypertrophic pyloric stenosis	❌ No HCC	Gastric outlet obstruction if FB trapped at pylorus

Psychiatric / Behavioral Ingestion

ICD-10-CM	Description	HCC (v28)	Notes
F98.3	Pica of infancy and childhood	❌ No HCC	Developmental/behavioral ingestion in pediatric patients
F50.89	Other specified eating disorder	❌ No HCC	Pica in adults with eating disorder diagnosis
F19.10	Other psychoactive substance abuse, uncomplicated	❌ No HCC	Body packing context (substance ingestion/concealment) — note contraindication to endoscopic removal
Z91.19	Patient’s noncompliance with other medical treatment	❌ No HCC	Intentional ingestion, refusal-related

Pediatric-Specific Considerations

ICD-10-CM	Description	HCC (v28)	Notes
T18.108A	Other foreign body in esophagus	❌ No HCC	Coins are the #1 pediatric esophageal FB in the U.S.
W44.01XA	Coin entering through orifice, initial encounter	❌ No HCC	Specific external cause code for coin ingestion — add as secondary code
W44.8XXA	Other inorganic foreign body entering through orifice, initial encounter	❌ No HCC	Toys, marbles, toy parts
Q39.3	Congenital stenosis and stricture of esophagus	❌ No HCC	Underlying congenital narrowing predisposing to pediatric FB lodgment

HCC Mapping Notes (CMS v28 Model)

💡 HCC Capture Opportunities — 43247 Context: The foreign body codes themselves (T18 series) do not carry HCC weight. However, the clinical encounter frequently surfaces significant comorbidities and complications that do carry HCC flags:

• Malnutrition (E43, E44.0) → HCC 21 — If dysphagia or esophageal pathology causing recurrent impaction has led to documented nutritional compromise, query the physician for malnutrition assessment. High-weight HCC frequently missed in this context.
• Esophageal Cancer (C15.x) → HCC 10 — Malignant stricture as underlying cause of food impaction; active malignancy codes must be captured.
• Aspiration Pneumonia (J69.0) → HCC 114 (Aspiration Pneumonitis/Pneumonia) — If food bolus aspiration or regurgitation during the episode results in aspiration pneumonia; document clearly.
• Psychiatric Diagnoses (e.g., schizophrenia F20.9 → HCC 157) — In patients with intentional ingestion related to psychiatric illness; psychiatric conditions carry HCC weight and should be captured. ^{CMS HCC Model v28 Mappings · ICD-10-CM FY2026 Guidelines}

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🏥 MS-DRG Mapping (Inpatient Context)

Inpatient Coder Note: CPT codes are not used in the inpatient setting. MS-DRG assignment is driven by ICD-10-CM principal diagnosis and ICD-10-PCS procedure codes. 43247 maps to the ICD-10-PCS root operation Extirpation for inpatient coding purposes. The DRG assignment varies significantly based on:

• Whether the foreign body caused complications (perforation, hemorrhage, obstruction)
• Whether the underlying diagnosis is an esophageal condition, GI bleed, or injury/trauma
• Presence of comorbid MCC or CC conditions

Esophageal / GI Foreign Body DRGs (MDC 06)

MS-DRG	Description	Typical GMLOS	When Assigned
391	Esophagitis, Gastroenteritis & Misc Digestive Disorders w MCC	~4.8 days	Esophageal FB or food impaction with MCC (e.g., aspiration pneumonia, malnutrition)
392	Esophagitis, Gastroenteritis & Misc Digestive Disorders w/o MCC	~2.8 days	Uncomplicated food bolus or esophageal FB, no significant comorbidities
377	GI Hemorrhage w MCC	~5.5 days	FB causing significant GI hemorrhage with MCC
378	GI Hemorrhage w CC	~3.5 days	FB-related GI bleeding with CC
379	GI Hemorrhage w/o CC/MCC	~2.3 days	Minor hemorrhage from FB

Injury / Trauma-Related DRGs (MDC 21 — Injuries, Poisonings & Toxic Effects)

MS-DRG	Description	Typical GMLOS	When Assigned
915	Allergic Reactions w MCC	~3.5 days	Anaphylactic/allergic reaction component to FB
919	O.R. Procedures for Injuries w MCC	~9.2 days	If open surgical intervention required for FB complication (perforation)
920	O.R. Procedures for Injuries w CC	~5.2 days	Same as above, CC present
963	Other Multiple Significant Trauma w MCC	~7.0 days	Multiple traumatic injuries + FB context

Pediatric Context

MS-DRG	Description	Notes
391 / 392	Esophagitis, Misc Digestive Disorders	Most common DRG for pediatric coin/FB ingestion without complications
All-Patient Refined (APR)	APR-DRG used in many pediatric hospitals	APR-DRG 141 (Esophagitis/Gastroenteritis) with severity-of-illness subclass typical for uncomplicated FB

⚠️ DRG Optimization Tips:

• Aspiration pneumonia (J69.0) resulting from food bolus regurgitation during the episode or procedure is an MCC — document and capture it. This shifts DRG to the higher-weight MCC variant.
• Esophageal perforation (K22.3) resulting from foreign body injury or procedure-related complication is a major complication that may shift the case to a higher-weighted surgical DRG if open repair is required.
• Malnutrition (E43) in patients with chronic dysphagia and recurrent impaction is an MCC — always query the physician when nutritional compromise is clinically apparent. ^{CMS MS-DRG Grouper FY2026 · UHDDS Principal Diagnosis Definition}

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🔩 ICD-10-PCS Crosswalk (Inpatient Procedure Coding)

Root Operation: Extirpation (C) — Taking or cutting out solid matter from a body part. In ICD-10-PCS, a foreign body is classified as “solid matter” → root operation = Extirpation. This applies whether the foreign body is retrieved through the scope, pulled out with the scope, or pushed into the stomach.

PCS Table Reference: Section 0 · Body System D · Root Operation C (Extirpation)

Character	Position	Value	Meaning
1 — Section	Medical & Surgical	0
2 — Body System	Gastrointestinal System	D
3 — Root Operation	Extirpation	C
4 — Body Part	See options below
5 — Approach	Via Natural or Artificial Opening Endoscopic	8
6 — Device	No Device	Z
7 — Qualifier	No Qualifier	Z

Body Part Options (Character 4)

Body Part Value	Body Part Name	When to Use
1	Upper Esophagus	FB in upper esophagus (cricoid level to thoracic inlet)
2	Middle Esophagus	FB at mid-thoracic esophagus level
3	Lower Esophagus	FB in lower thoracic or abdominal esophagus/GEJ
5	Esophagus	Use when esophageal segment is unspecified or spans multiple levels
6	Stomach — Cardia	FB lodged at gastric cardia specifically
7	Stomach — Fundus	FB in gastric fundus
8	Stomach — Body	FB in gastric body
9	Pylorus	FB impacted at the pyloric channel
B	Small Intestine	FB in duodenum/proximal jejunum
A	Jejunum	FB in jejunum if accessed by push enteroscopy during same session

Compiled ICD-10-PCS Codes — Most Commonly Used

PCS Code	Full Description	Use When
0DC58ZZ	Extirpation of Matter from Esophagus, Endoscopic	Esophageal FB or food bolus, unspecified esophageal segment
0DC18ZZ	Extirpation of Matter from Upper Esophagus, Endoscopic	Upper esophageal foreign body
0DC28ZZ	Extirpation of Matter from Middle Esophagus, Endoscopic	Mid-esophageal foreign body
0DC38ZZ	Extirpation of Matter from Lower Esophagus, Endoscopic	Lower esophageal/GEJ foreign body
0DC68ZZ	Extirpation of Matter from Stomach, Endoscopic	Gastric foreign body (general)
0DC98ZZ	Extirpation of Matter from Pylorus, Endoscopic	FB trapped at pyloric channel
0DCB8ZZ	Extirpation of Matter from Small Intestine, Endoscopic	Duodenal/proximal jejunal foreign body

When Dilation is Also Performed (Combined PCS Coding)

If the endoscopist also performs dilation of an underlying esophageal stricture discovered at the same session, a second ICD-10-PCS code is added for the dilation (root operation = Dilation, body system D, approach 8). Both procedures are coded because they involve different root operations and represent distinct, complete procedures in PCS logic. This is not double-counting — it reflects the complete inpatient procedural picture. ^{ICD-10-PCS Official Guidelines FY2026 Section B3.2}

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🏷️ Applicable Modifiers

Modifier	Name	Application to 43247
-22	Increased Procedural Services	Unusually complex or prolonged foreign body removal — extensive impaction, multiple passes, difficult anatomy, use of overtube with multiple retrieval attempts, sharp object removal requiring specialized technique; attach operative report with detailed documentation of complexity
-52	Reduced Services	Procedure initiated but only partially completed — foreign body partially engaged but not successfully removed, scope advanced but FB not reachable; procedure substantially less than typically required
-53	Discontinued Procedure	Procedure terminated after sedation/anesthesia administered due to patient safety concern before retrieval was possible — e.g., hemodynamic instability, airway compromise, suspected perforation on initial visualization
-59	Distinct Procedural Service	For a second, separately medically necessary procedure performed at a distinct anatomic site or for a distinct indication during the same session — e.g., 43248 dilation of a separately identified stricture after food bolus removal; requires robust documentation of distinct medical necessity
-XU	Unusual Non-Overlapping Service	CMS preferred alternative to -59 for same-day distinct services; same documentation requirements
-47	Anesthesia by Surgeon	Applicable only if the performing endoscopist personally administers general anesthesia — not moderate sedation, which is always bundled into 43247
-GC	Teaching Physician Service	Academic/teaching hospital — resident participates; attending documents personal presence and key portions of procedure
-GE	Resident Without Supervising Physician	Primary care exception — limited applicability for this procedure
-76	Repeat Procedure by Same Physician	If repeat endoscopy is necessary same day (e.g., first pass removed most of impaction; second endoscopy hours later to verify complete clearance and assess mucosa); document clinical necessity for repeat session
-RT / -LT	Right/Left	Not applicable — upper GI procedures are midline
-PD	Diagnostic or Related Non-Diagnostic Service	Not commonly used here; may apply if Medicare Advantage plans require it for bundled payment purposes

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📝 Coding Examples

Example 1 — Esophageal Food Bolus (Meat) Impaction, Underlying Schatzki Ring

Scenario: A 64-year-old male presents to the ED with inability to swallow secretions and a sensation of meat stuck in his chest for 3 hours after eating steak. CXR negative for free air. Emergent EGD performed. A large meat bolus is visualized impacted in the distal esophagus at 38 cm. Retrieved en bloc using a Roth retrieval net after fragmentation. Post-retrieval assessment reveals a Schatzki ring at 40 cm with an underlying peptic stricture. No perforation or significant mucosal injury noted.

Professional / Outpatient Billing:

• 43247 — EGD with removal of foreign body (food bolus retrieval — primary)
• Consider 43248 or 43249 — if the Schatzki ring/stricture was also dilated during the same session, append with modifier -59/[-[XU]]; NCCI edits require documentation of distinct medical necessity

ICD-10-CM:

• T18.120A — Foreign body in esophagus causing other injury, initial encounter (principal — food bolus)
• K22.2 — Esophageal obstruction (secondary — Schatzki ring/stricture component)
• K21.00 — GERD with esophagitis without bleeding (secondary — underlying etiology if documented)

ICD-10-PCS (if inpatient):

• 0DC38ZZ — Extirpation of Matter from Lower Esophagus, Endoscopic
• 0D738ZZ — Dilation of Lower Esophagus, Endoscopic, No Device (if dilation also performed)

MS-DRG: 392 — Esophagitis, Gastroenteritis & Misc Digestive Disorders w/o MCC

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Example 2 — Button Battery Ingestion, Esophageal (Pediatric Emergency)

Scenario: A 2-year-old male brought to the ED by parents after being found with a remote control. AP/lateral neck and chest X-ray reveals a circular metallic object with “halo/double-ring” sign at the level of the cricopharyngeus — consistent with a button battery. Emergent EGD performed under general anesthesia (anesthesiologist independently administers GA). The button battery is visualized at 15 cm from the incisors, lodged at the upper esophagus. Circumferential mucosal hyperemia and early necrosis noted around the battery. Battery retrieved using alligator forceps with overtube protection. Post-retrieval assessment shows a 2 cm zone of mucosal necrosis at the lodgment site; no transmural perforation identified endoscopically. Otolaryngology on standby.

Professional / Outpatient Billing:

• 43247 — EGD with removal of foreign body (by performing gastroenterologist/surgeon)
• Anesthesiologist bills separately under appropriate anesthesia CPT code — performing endoscopist does NOT bill 99152/99153

ICD-10-CM:

• T18.118A — Other foreign body in esophagus causing compression of trachea, initial encounter (if tracheal compression documented) OR
• T18.128A — Other foreign body in esophagus causing other injury, initial encounter (if injury without tracheal compression)
• W44.A1XA — Button battery entering through orifice, initial encounter (external cause — add as secondary)
• K22.8 — Other specified diseases of esophagus (mucosal necrosis at lodgment site — secondary)

ICD-10-PCS (if inpatient):

• 0DC18ZZ — Extirpation of Matter from Upper Esophagus, Endoscopic

MS-DRG: 391 — Esophagitis, Gastroenteritis & Misc Digestive Disorders w MCC (if mucosal necrosis/injury complexity constitutes MCC; verify DRG grouper)

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Example 3 — Coin Ingestion in Child (Non-Emergent), Outpatient

Scenario: A 4-year-old female swallowed a penny 18 hours ago. Parents note drooling and mild dysphagia. Plain film shows a single round radiopaque object at the level of the aortic arch in the mid-esophagus. Elective same-day EGD performed. Coin visualized at 22 cm from incisors. Retrieved using a Dormia basket. Esophageal mucosa shows mild pressure erosion at the site but no perforation. Procedure well tolerated under moderate sedation by CRNA (independent provider).

Professional / Outpatient Billing:

• 43247 — EGD with removal of foreign body (performing endoscopist)
• CRNA / anesthesia provider bills separately if they independently administered sedation

ICD-10-CM:

• T18.108A — Other foreign body in esophagus causing other injury, initial encounter
• W44.01XA — Coin entering through orifice, initial encounter (external cause — secondary)

ICD-10-PCS (if inpatient):

• 0DC28ZZ — Extirpation of Matter from Middle Esophagus, Endoscopic

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Example 4 — Gastric Foreign Body (Sharp Object), Adult

Scenario: A 29-year-old male with a history of schizophrenia, admitted from a psychiatric facility after witnessed ingestion of an open safety pin. Abdominal X-ray confirms the safety pin in the gastric body, open end facing the pylorus, representing imminent risk if it passes. Urgent EGD performed. Safety pin visualized in the gastric body, open prong facing the pylorus. Retrieved carefully using rat-tooth forceps, with the safety pin oriented and pulled through the GEJ and esophagus with the closed end leading and use of an overtube to protect the mucosa on extraction. No mucosal injury. Psychiatric consultation obtained.

Professional / Outpatient Billing:

• 43247-22 — EGD with removal of foreign body, increased procedural complexity (sharp object removal with overtube, careful orientation technique; document complexity in operative note)

ICD-10-CM:

• T18.2XXA — Foreign body in stomach, initial encounter (gastric location)
• W45.8XXA — Other foreign body or object entering through skin, initial encounter — Note: if the object pierced mucosa on retrieval, a wound code may also apply; otherwise use the T18 code only for ingestion context
• F20.9 — Schizophrenia, unspecified (secondary — psychiatric comorbidity; maps to HCC 157 under v28 — capture this HCC)

ICD-10-PCS (if inpatient):

• 0DC68ZZ — Extirpation of Matter from Stomach, Endoscopic

MS-DRG: 391 or 392 depending on final CC/MCC assessment; F20.9 as CC may affect grouping

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Example 5 — Food Impaction with EoE Identified, Biopsies Obtained, Same Session

Scenario: A 26-year-old male presents with complete food (bread) impaction in the mid-esophagus. EGD performed; bread bolus removed using a Roth net after fragmentation. Post-retrieval assessment reveals characteristic endoscopic features of eosinophilic esophagitis: trachealization (circular rings), linear furrowing, and mucosal pallor/edema. Biopsies obtained from mid and distal esophagus (4 biopsies each site, per EoE consensus protocol) for histologic confirmation.

Professional / Outpatient Billing:

• 43247 — EGD with removal of foreign body (primary)
• Biopsies: Review current NCCI edits. If biopsies are obtained at the same site as the foreign body, they are typically bundled. If biopsies are obtained at distinct esophageal sites for the purpose of diagnosing a separately identified condition (EoE), some payers support separate biopsy code (e.g., 43202) with modifier -59/-XU and clear documentation. Verify with current NCCI tables and your MAC’s LCD before billing separately.

ICD-10-CM:

• T18.128A — Other foreign body in esophagus causing other injury, initial encounter (food bolus)
• K20.00 — Eosinophilic esophagitis without bleeding (secondary — identified at same session; code even if histologic confirmation pending, if clinician documents the endoscopic diagnosis)

ICD-10-PCS (if inpatient):

• 0DC28ZZ — Extirpation of Matter from Middle Esophagus, Endoscopic

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Example 6 — Teaching Hospital, Modifier GC

Scenario: Level I academic medical center. GI fellow performs EGD and foreign body retrieval under direct attending supervision. Attending is present throughout the critical portions of the procedure and documents: “I was present and personally participated in the key portions of the procedure, including foreign body retrieval.”

Professional Billing:

• 43247--GC — Teaching physician modifier confirms compliance with Medicare teaching physician rules; attending attestation in the operative note is mandatory

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Example 7 — Iatrogenic / Migrated Capsule Endoscopy Device

Scenario: A 52-year-old female with known small bowel Crohn’s disease underwent capsule endoscopy 10 days ago. Follow-up imaging reveals the capsule retained in the proximal duodenum near a stricture. Patient has developed partial small bowel obstruction symptoms. EGD with push enteroscopy performed; capsule identified in the descending duodenum. Retrieved using a polypectomy snare. Stricture assessed; patient referred for further evaluation.

Professional / Outpatient Billing:

• 43247 — EGD with removal of foreign body (capsule device — iatrogenic retained foreign body)

ICD-10-CM:

• T18.3XXA — Foreign body in small intestine, initial encounter (duodenal location)
• K50.10 — Crohn’s disease of large intestine without complications (underlying diagnosis; code specific Crohn’s subtype per documentation)

ICD-10-PCS (if inpatient):

• 0DCB8ZZ — Extirpation of Matter from Small Intestine, Endoscopic

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⚙️ Billing & Reimbursement Notes

• Medicare Coverage: No standalone NCD for endoscopic foreign body removal. Coverage adjudicated by MAC per LCD. Medical necessity is generally well-established for foreign body removal and food bolus impaction. Documentation must establish:

  • Confirmed or highly suspected foreign body by history, symptoms, and/or imaging
  • Anatomic location accessible by EGD (esophagus, stomach, proximal duodenum)
  • Clinical necessity for endoscopic removal (object type, size, location, symptoms, risk of spontaneous passage)

• Place of Service (POS):

  • POS 22 — Hospital Outpatient / HOPD (most food bolus and non-emergent FBs)
  • POS 21 — Inpatient Hospital (admitted patients, complex cases)
  • POS 23 — Emergency Room (when procedure is performed in the ER setting itself, though frequently transferred to endoscopy suite with POS 22 or 21)

• One Unit Per Session: 43247 is always reported as one unit per session regardless of how many foreign bodies are removed or how many retrieval passes are required.

• Fluoroscopy Billing: Pre-procedure localization X-rays (e.g., AP/lateral chest for coin) are separately reportable as diagnostic imaging; they are not bundled into the endoscopic procedure itself. Fluoroscopic guidance used during the endoscopic procedure may or may not be separately billable depending on MAC LCD — verify before billing 74360.

• Anesthesia: If general anesthesia is administered by an anesthesiologist (common in pediatric patients and proximal esophageal/sharp object cases), the anesthesiologist bills under anesthesia CPT codes separately. The endoscopist does not report 99152 or 99153 regardless.

• Overtube Use: Use of a protective overtube during sharp object retrieval does not change the CPT code selection. It may, however, support modifier 22 when the use of an overtube substantially increased procedure complexity, time, or technical difficulty.

• Push Technique for Food Bolus: When a food bolus is pushed into the stomach rather than retrieved proximally, 43247 remains the appropriate code — the operative note must document the push technique clearly. Some payers may require documentation that retrograde retrieval was not feasible or safe before accepting the push technique claim.

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🔗 Related Codes & Cross-References

Code	Description	Relationship
43235	Diagnostic EGD	Base code; bundled into 43247
43248	EGD with guide wire dilation	May follow FB removal if underlying stricture found; NCCI edits apply
43249	EGD with balloon dilation, esophagus < 30 mm	TTS balloon dilation of underlying stricture post-FB removal; NCCI edits apply
43251	EGD with snare polypectomy	Snare removal of polyp/tumor — distinct from snare FB retrieval
43255	EGD with control of bleeding, any method	Hemostasis for FB-related hemorrhage; NCCI bundling rules apply same session
43020	Esophagotomy, cervical — removal of FB	Open surgical approach when endoscopy fails
43045	Esophagotomy, thoracic — removal of FB	Open thoracic surgical approach
T18.100A	Unspecified FB in esophagus, no compression, initial	ICD-10-CM primary diagnosis — esophageal FB
T18.2XXA	Foreign body in stomach, initial encounter	Gastric FB
T18.3XXA	Foreign body in small intestine, initial encounter	Duodenal/jejunal FB
W44.A1XA	Button battery entering through orifice, initial	External cause — button battery ingestion
W44.01XA	Coin entering through orifice, initial	External cause — coin ingestion
K20.00	Eosinophilic esophagitis without bleeding	Most common underlying predisposing condition in young adults
K22.2	Esophageal obstruction	Underlying structural cause; Schatzki ring, stricture
F20.9	Schizophrenia, unspecified	Psychiatric comorbidity — HCC 157; intentional ingestion
E43	Severe protein-calorie malnutrition	Nutritional complication from chronic dysphagia — HCC 21
0DC58ZZ	Extirpation of Esophagus, Endoscopic	ICD-10-PCS inpatient — esophageal FB, unspecified segment
0DC68ZZ	Extirpation of Stomach, Endoscopic	ICD-10-PCS inpatient — gastric FB
0DCB8ZZ	Extirpation of Small Intestine, Endoscopic	ICD-10-PCS inpatient — duodenal/jejunal FB

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^{AMA CPT 2026 Professional Edition · CMS Physician Fee Schedule 2026 Final Rule · CMS NCCI Policy Manual v32 · ICD-10-CM Official Guidelines for Coding and Reporting FY2026 · ICD-10-PCS Official Guidelines FY2026 · CMS-HCC Risk Adjustment Model v28 · AHA Coding Clinic for ICD-10-CM/PCS · CMS MS-DRG Grouper FY2026 · UHDDS Principal Diagnosis Definition · ASGE Guideline: Management of Ingested Foreign Bodies and Food Impactions, Gastrointest Endosc 2023 · Kramer RE et al., NASPGHAN Guidelines for Management of Ingested Foreign Bodies, JPGN 2015 · Birk M et al., ESGE Guideline — Endoscopic Approach to Foreign Bodies in the Upper GI Tract, Endoscopy 2016 · National Capital Poison Center — Button Battery Ingestion Triage Guidelines 2024}