Diagnostic and Therapeutic Esophagogastroduodenoscopy

Esophagogastroduodenoscopy (EGD) is covered for diagnostic evaluation of persistent or worrisome upper GI symptoms (e.g., refractory GERD, dysphagia, unexplained vomiting), for imaging findings requiring biopsy or evaluation of suspected malignancy/obstruction, and for therapeutic purposes (hemostasis, foreign body removal, variceal therapy, dilation, PEG placement, palliative stenting). Follow-up EGDs are covered for surveillance such as Barrett's esophagus (every 12–24 months; 3–6 months if dysplasia) and for recurrent therapeutic needs, while routine periodic surveillance of healed benign disease and EGD for cancer surveillance in certain historic conditions (pernicious anemia, treated achalasia, prior gastric resection) are not usually indicated; EGD is generally contraindicated soon after myocardial infarction. Documentation should include prior therapy trials, pertinent imaging or colon evaluation results, definitive diagnoses before dilation, biopsy/pathology for surveillance, and procedure/sedation notes.