Gastroenterology Coding Alert

Reviewed on May 15, 2015 Payment is down for endoscopic ultrasound procedures performed with fine needle aspiration, but you can capture your practice’s maximum, ethical reimbursement by following five simple steps. Step 1: Determine EUS Code The ultrasound codes for the upper endoscopies are used to measure depth of lesions “masses or tumors in the lungs esophagus and pancreas,” says Vonda Reeves-Darby MD Gastrointestinal Associates Jackson Miss. When the physician uses an esophagoscope with endoscopic ultrasound (EUS) you should report 43231  (Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination). For an esophagogastroduodenoscopy (EGD) with EUS assign 43259  (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis). Use the same code for an EUS of the pancreas. Remember if the physician does not examine past the esophagus code an esophagoscopy (43231). However, “an esophagoscopy becomes an EGD (43259) when the pyloric channel has been reached,” says Linda Ming, CPC, Gastrointestinal Associates, Jackson, Miss. In addition, a documented reason must exist for examining the liver adrenal gland or pancreas. “Sigmoidoscopies also have ultrasound codes,” Reeves-Darby explains. “These are sometimes used when the patient has had fecal incontinence or scar tissue.” For a flexible sigmoidoscopy with EUS bill 45341 (Sigmoidoscopy flexible; with endoscopic ultrasound examination). Step 2: Combine Appropriate EUS and FNA Codes Each of the above EUS codes corresponds to a fine needle aspiration (FNA) code. When the gastroenterologist performs esophagoscopy with EUS and FNA report 43232  (Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s]). For EGD with EUS/FNA assign (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s] [includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis). For a rectal exam with EUS/FNA use flexible sigmoidoscopy code (Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy[s]). Do not report the EUS code in addition to the FNA code. For example, suppose a gastroenterologist performs an EGD with EUS/FNA. Bill 43242 only. CPT® includes the diagnostic EGD code (43259) in the surgical EGD (43242). Step 3: Bill Allowed Radiology Codes When the physician supervises and interprets the needle placement or the endoscopic ultrasound, CPT® and the Correct Coding Initiative (CCI) have prohibited the use of two radiology codes:   76942 Ultrasonic guidance for needle placement (e.g. biopsy aspiration injection localization device) imaging supervision and interpretation   76975 Gastrointestinal endoscopic ultrasound supervision and interpretation.  You cannot report 45342 with 76942 or 76975 When 76942 is performed with 43232 or 43242 report the surgical procedure only. CCI 8.1 [...]