Gastroenterology Coding Alert
Looking for EUS Codes? Find Them Here
Question: What is EUS, and how should I code for it? Coding scenario: The gastroenterologist sees a patient with an esophageal tumor in the endoscopy suite for an esophagogastroduodenoscopy (EGD). The gastroenterologist performs the EGD using EUS on the patient's esophagus only. On the claim, you should: If the physician uses the EUS all the way to the stomach or intestine, you should report 43242 (with fine needle biopsy) or 43259 (without biopsy). This may occur if the physician is looking for gastric ulcers, tumors, duodenal masses, strictures, pancreatic mass, pancreatic pseudocyst or ampullary (major papilla) masses, for example.
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Answer: EUS is an abbreviation for endoscopic ultrasound, which physicians generally use during upper gastrointestinal endoscopy.
CPT contains four codes for upper EUS, according to location (esophagus, or stomach and small intestine) and whether the physician takes a biopsy:
- 43237--Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus for EUS without biopsy
- 43238--... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus) for EUS-guided biopsy
- 43242--... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/ biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate) for EUS-guided biopsy
- 43259--... with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate for EUS without biopsy.
- report 43237 for the EGD with endoscopic EUS
- attach 150.9 (Malignant neoplasm of esophagus; unspecified) to represent the patient's tumor.
Example: A patient with a gastric ulcerating mass meets the gastroenterologist in the endoscopic suite for an EGD. The gastroenterologist performs the EGD, using EUS on the gastric mass. On the claim, you should:
- report 43259 for the EGD with EUS
- attach 531.9x (Gastric ulcer; unspecified as acute or chronic, without mention of hemorrhage or perforation).
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