Help with EUS with FNA

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Long Beach, CA
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I am not sure if I am reading this code description correctly. Can anyone tell me what code would be most appropriate for this report and why choose one code over the other? I am having a difficult time deciding on applying either 43242 or 43238. my example is below. (I am reading description for cpt 43242 as the jejunum is examined in either scenario?) Thank you in advance.

(The Linear Ultrasound scope was
introduced through the mouth, and advanced to
the second part of duodenum. The scope
was introduced through the mouth, and
advanced to the second part of duodenum. The
upper EUS was accomplished without difficulty.

Endoscopic Finding :
The examined esophagus was endoscopically normal.
The entire examined stomach was endoscopically normal.
The examined duodenum was endoscopically normal.
Endosonographic Finding :
A round hypoechoic mass like lesion was identified in the head. The
mass measured 29 mm by 27 mm in maximal cross-sectional diameter.
The endosonographic borders were poorly-defined. The remainder of
the pancreas was examined. The endosonographic appearance of
parenchyma and the upstream pancreatic duct indicated no duct
dilation. Fine needle aspiration for cytology was performed. Color
Doppler imaging was utilized prior to needle puncture to confirm a
lack of significant vascular structures within the needle path. Two
passes were made with the 22 gauge needle using a transgastric
approach. Some passes were made with a stylet. A cytologist was
present and performed a preliminary cytologic examination. The
cellularity of the specimen was adequate.
An irregular hypoechoic lesion was identified endosonographically in
the left lobe of the liver. The lesion was heterogenous, irregular
in shape and appeared to have solid and cystic components in it.
Calcifications with shadowing were appreciated in it. The lesion
measured 24 mm by 26 mm in maximal cross-sectional diameter. The
endosonographic borders were well-defined. Fine needle aspiration
for cytology was performed. Color Doppler imaging was utilized prior
to needle puncture to confirm a lack of significant vascular
structures within the needle path. Two passes were made with the 22
gauge needle using a transgastric approach. Some passes were made
with a stylet. A cytologist was present and performed a preliminary
cytologic examination. The cellularity of the specimen was adequate.
There was dilation in the left intrahepatic bile duct(s) and in the
right intrahepatic bile duct(s).
One stent was visualized endosonographically in the common bile
duct. Extension of the stent was noted in the common bile duct.
A few malignant-appearing lymph nodes were visualized in the
peripancreatic region. The largest measured 10 mm by 8 mm in maximal
cross-sectional diameter. The nodes were round, hypoechoic and had
well defined margins.
Multiple irregularly shaped lesions were found in the spleen. They
were hypoechoic.]
 

llhogeland

Contributor
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Park City, KS
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Limited vs multiple

The difference is whether or not the EUS was limited to one area or is multiple areas were viewed. Your EGD speaks of the Esophagus, stomach and duodenum, the EUS speaks of the pancreas, liver and even spleen. So this would be 43242. In the descriptions there is a very small wording difference. The 43238 says "Esophagus, stomach OR duodenum. The 43242 says Esophagus, stomach AND duodenum/Jejunum. If this does not make sense or you have further questions, private message me and I will try to help. Thanks! :)
 
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