Use this guideline to review for Video Capsule Endoscopy when indicated for the evaluation of Peutz-Jehgers Syndrome starting at age 8.
What is CAPEND - 5 Genetic Syndromes?
Surveillance EGD is indicated for individuals whose gastric ulcer appears endoscopically suspicious for malignancy even if biopsies are benign, after this treatment.
What is 8-12 weeks of PPI and/or H. Pylori Treatment?
EGD 1.4
This CPT code is indicated for the evaluation of known or suspected Crohn's Disease
What is CPT 91110 Capsule Endoscopy?
CAPEND - 1
In the evaluation of esophageal varices in cirrhotic individuals who are unable to tolerate or undergo EGD
What is Esophageal Capsule Endoscopy (CPT 91111?)
CAPEND - 8
What is CAPEND - 4
Small Bowel Tumors
Study appropriate for individuals with duodenal ulceration (Refractory Ulcers) who experience persistent symptoms despite an appropriate course of therapy
What is Surveillance EGD until healing is documented?
EGD 1.5 Duodenal Ulcer
This CPT code is indicated when endoscopic procedures may be inappropriate in individuals with non reversible coagulopathy
What is Esophageal Capsule Endoscopy (CPT 91111?)
CAPEND 8
This study is appropriate at any age with the presence of a family history of Esophageal cancer associated with dyspeptic or upper abdominal symptoms
What is EGD?
EGD 1.1
The presence or absence of Dysplasia with Gastric Intestinal Metaplasia (GIM) can be reviewed with this guideline
What is EGD 1.6
Gastric Intestinal Metaplasia (GIM)
Epigastric pain suggesting pancreatic or biliary sources should generally undergo this study prior to EGD
What is Cross sectional imaging?
EGD 1.1
If the individual's history is consistent with typical or uncomplicated GERD, this would be appropriate prior to Endoscopy
What is Empiric medical therapy?
EGD-2
"Background and supporting information"
Individuals who have undergone curative resection of colon or rectal cancer must have this study post operatively
What is a Colonoscopy?
COLON-4
A Clinically indicated Endoscopy for a known esophageal Malignancy would be reviewed using this guideline
What is EGD 1.15 - Known Malignancies
These 3 findings from the initial baseline Colonoscopy with Polypectomy must be provided in order to utilize the proper application of the surveillance guidelines
What is the size, number and histologic findings?
COLON-3
In the surveillance for Barrett's Esophagus initial pathology findings suggestive of dysplasia of any grade should be confirmed by this.
What is a second pathologist?
Iron deficiency anemia UGI in origin manifested by low hematocrit and low serum iron warrant this imaging
What is an EGD?
EGD 1.2
Using this guideline, This study should be performed within 6 months of the diagnosis of pernicious anemia.
What is EGD
EGD 1.10 Pernicious Anemia
If surgical resection is not performed prior, this annual surveillance of GIST's smaller than 2 cm may be performed.
What is EUS/EGD Surveillance
EGD 1.11 GIST (Gastrointestinal Stromal Tumors)
This CPT code is indicated as a primary procedure in individuals with a major risk for standard optical colonoscopy or moderate sedation AND a positive fecal occult blood test
What is CPT (91113) Colon Capsule Endoscopy
CAPEND 7
If pathology is indefinite for dysplasia on initial screening EGD
What is repeat EGD in 3-6 months?
EGD 1.3 Barrett's Esophagus