You Be the Coder:
EUS Limited to Esophageal Areas
Published on Sat Feb 05, 2005
Question: Our doctor performed an upper gastrointestinal endoscopy (EGD) on a patient and used endoscopic ultrasound on the esophagus. We filed 43242 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; 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]) on the claim and got a denial. Why?
Connecticut Subscriber
Answer: Your coding probably would have been accepted in 2003, but it isn't specific enough these days.
In 2004, CPT revised its code set for EGDs with EUS. If the physician's notes on an EGD indicate that the gastro used EUS only on the esophagus, choose from the following:
43237 - Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus
43238 - Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus). Exception: There are also instances in which the gastro will use EUS past the esophagus during an EGD.
If the physician's notes on an EGD indicate that she used EUS on the esophagus and extended to the stomach or small intestine, report one of the following codes: 43242 - Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; 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)
43259 - Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate.
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