Clinical Indications for an upper G.I. endoscopy, procedure code 194, are listed below. No Consultant or hospital benefits are payable for a repeat upper G.I. endoscopy within a 12 month period except for those clinical indications listed below as "Repeat endoscopy". New clinical indications unrelated to the indications(s) for an earlier endoscopy within the 12 month period, themselves identified indication(s) for endoscopy, will not be excluded by a prior endoscopy. No Consultant or hospital benefits are payable for a surveillance upper G.I. endoscopy except for those clinical indications listed below as "Surveillance endoscopy". Procedure code 194 is not claimable in conjunction with procedure codes 198, 202 or 271. Ind. Code Clinical Indicators 692 a) Initial endoscopy: Upper abdominal/Oesophageal reflux symptoms that persist in patients that have been tested and received treatment for Helicobacter pylori 693 b) Initial endoscopy: Upper abdominal symptoms or signs suggesting organic disease in patients > 45 years old 694 c) Initial endoscopy: Dysphagia or Odynophagia 695 d) Initial endoscopy: Upper abdominal/Oesophageal reflux symptoms that are persistent or recurrent in patients who have been treated with a trial of PPIs for 6 weeks or more 696 e) Initial endoscopy: Persistent vomiting of unknown cause 697 f) Initial endoscopy: Biopsy for suspected coeliac disease 698 g) Initial endoscopy: Other diseases in which the presence of upper GI pathologic conditions might modify other planned management (i.e. patients who have a history of ulcer or GI bleeding who are scheduled for organ transplantation, long term anti-coagulation or long-term non-steroidal anti-inflammatory drug therapy for arthritis, and those with cancer of the head and neck) 712 h) Initial endoscopy: For confirmation and specific histological diagnosis of radiologically demonstrated suspected or suspected upper GI tract lesion 701 i) Initial endoscopy: Patients with active/recent GI bleeding 713 j) Initial endoscopy: Iron deficiency anaemia 702 k) Initial endoscopy: Patients with suspected portal hypertension to document or treat oesophageal varices 703 l) Initial endoscopy: To assess acute injury after caustic ingestion 704 m) Initial endoscopy: Treatment of bleeding lesions such as ulcers, tumours, vascular abnormalities (e.g. electro-coagulation, heater probe, laser photocoagulation, or injection therapy) 709 n) Initial endoscopy: Further investigation of suspected achalasia 808 o) Initial endoscopy: Pernicious Anaemia: Benefit will be provided for a single endoscopy 782 p) Initial endoscopy: Other exceptional reasons will be considered provided a comprehensive medical report accompanies the claim outlining the medical necessity for the procedure 620 pa) Initial endoscopy: Unexplained weight loss 621 pb) Initial endoscopy: Further investigation of an upper abdominal mass 622 pc) Initial endoscopy: Early satiety 1 q) Repeat endoscopy: Previously diagnosed Grade D oesophagitis or gastric or oesophageal ulcer: Benefit will be provided for repeat endoscopy to check for healing or to re-biopsy until healed 809 r) Repeat endoscopy: Patients diagnosed with an atypical (non-H. pylori-associated) or high-risk duodenal ulcer: Benefit will be provided for one repeat endoscopy to re-biopsy (except by report) 2 s) Repeat endoscopy: Coeliac Disease – re-check for healing 3–12 months after diagnosis (once only) 4 t) Repeat endoscopy: Monitoring of oesophageal varices in patients with portal hypertension 5 u) Repeat endoscopy: Stent blockage 810 v) Repeat endoscopy: Follow up of patients post gastric or oesophageal cancer: Benefit will be provided for endoscopies as clinically indicated 811 w) Repeat endoscopy: Gastric polyp (except fundic gland polyp): Benefit will be provided for repeat endoscopy at 1 year 718 x) Repeat endoscopy: Patient with a major bleed in whom the initial gastroscopy failed to identify the source of bleeding 719 y) Repeat endoscopy: Post treatment of bleeding ulcer or Mallory-Weiss tear 780 z) Surveillance endoscopy: Barrett’s mucosa (columnar-lined oesophagus) of less than 3 cms without dysplasia on previous endoscopy: Repeat endoscopy every 3 years 812 za) Surveillance endoscopy: Barrett’s mucosa (columnar-lined oesophagus) of greater than 3 cms without dysplasia on previous endoscopy: Repeat endoscopy every 2 years 813 zb) Surveillance endoscopy: Barrett's mucosa (columnar-lined oesophagus) with low-grade dysplasia on previous endoscopy: Repeat endoscopy every 6 months until 2 consecutive endoscopies with no dysplasia. 814 zc) Surveillance endoscopy: Barrett's mucosa (columnar-lined oesophagus) with high-grade dysplasia on previous endoscopy: Repeat endoscopy every 3 months 930 zcc) Surveillance post endoscopic treatment (RFA/EMA) of Barrett’s oesophagus – Benefit allowed every 3 months 815 zd) Surveillance endoscopy: Gastric intestinal metaplasia/atrophic gastritis with no dysplasia: Repeat endoscopy every 3 years 816 ze) Surveillance endoscopy: Gastric intestinal metaplasia/gastric epithelial dysplasia/atrophic gastritis with low-grade dysplasia: Repeat endoscopy at 12 months 817 zf) Surveillance endoscopy: Gastric intestinal metaplasia/gastric epithelial dysplasia/atrophic gastritis with high-grade dysplasia: Repeat endoscopy at 6 months 818 zg) Surveillance endoscopy: Familial adenomatous polyposis (FAP): OGD every 2 years starting at age 18 years 819 zh) Surveillance endoscopy: Peutz-Jeghers syndrome: OGD every 2 years starting at age 18 years 820 zi) Surveillance endoscopy: Juvenile polyposis: OGD every 3 years starting at age 18 years 821 zj) Surveillance endoscopy: Lynch Syndrome: OGD every 2 years starting at age 50 years 822 zk) Surveillance endoscopy: MUTYH-associated polyposis (MAP): OGD every 3 years starting at age 30 years