General Surgery Coding Alert

Your hard-earned $$$ could be on the line.

The three codes might not be together in CPT®, but they represent one continuum for reporting endoscopic ultrasound (EUS) with biopsy or fine needle aspiration (FNA).

Follow our expert's four tips to make sure you pick the right code and avoid making a $132 mistake.

Tip 1: Round Up the Codes and Costs

Don't let the CPT® "esophagus" heading confuse you: Some of the endoscopy codes go all the way to the jejunum. For endoscopy procedures that include EUS with biopsy or FNA specimen extraction, you should choose one of the following three codes (fees noted with each code based on non-facility Medicare Physician Fee Schedule, conversion factor 34.0376):

• 43232 -- Esophagoscopy, rigid or flexible; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)$265.15
• 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)$297.49›› ››
• 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)$429.89.

Tip 2: Know the Scope Distance

The three codes are from two different families based on how far the surgeon advances the endoscope in the upper gastrointestinal (GI) tract.

Code 43232 describes an esophagoscopy, meaning that the surgeon doesn't advance the scope beyond the esophagus.

On the other hand, 43238 and 43242 describe upper GI endoscopies in which the surgeon visualizes the esophagus, stomach, and the duodenum and/or jejunum.

Tip 3: Know the EUS Distance

CPT® distinguishes the codes based on how far the surgeon uses the EUS. If the surgeon performs ultrasound examination limited to the esophagus when taking a biopsy or FNA specimen, you must choose between 43232 and 43238.

For instance: You should select 43232 for an esophagoscopy if your surgeon uses EUS within the esophagus "to aspirate or biopsy a mass of the esophagus that is suspicious for malignancy," says Heather Copen, RHIT, CCS-P, Financial Advocate, Indiana University Health-Goshen Physicians, Goshen, Indiana

On the other hand: If the surgeon takes a biopsy or FNA while using EUS to examine beyond the esophagus into the stomach and duodenum/jejunum, you should turn to 43242.

"This procedure may be used to aspirate or biopsy a mass that may be suspicious for malignancy in the stomach, duodenum, and/or jejunum," Copen says.

Tip 4: Double Check Documentation

Make sure you read the op note carefully to find both the endoscope and EUS distance. Missing one or the other could cost your practice fees that you deserve.

For example: If your surgeon takes an EUS-guided esophageal biopsy, but you fail to note that he completes an endoscopy thorough the duodenum or jejunum, you might choose 43232 instead of 43238 and lose $32.

Even worse, if the surgeon documents an upper GI endoscopy with EUS examination of the esophagus, stomach, and the duodenum, but takes a biopsy from the esophagus, you might erroneously code 43238 instead of 43242. In that case, you would stand to lose $132.