# Help with EUS with FNA



## speedrcrsd (Mar 15, 2017)

*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.]


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## llhogeland (Mar 16, 2017)

*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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## speedrcrsd (Mar 16, 2017)

Thank you! I tend to not read thoroughly in the description of the cpt. Thank you so much for helping me break down the description!


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## shruthi (Oct 19, 2022)

Reopening the old post for my better understanding.

In this report EDG is complete, ultrasound scope has reached from mouth till duodenum as per the header description. But in the Endosonographic finding, there is no documentation of Esophagus, stomach, duodenum being evaluated by ultrasound. EUS of accessory organs are documented for FNA, but along with that EUS findings for 3 regions should also be documented to consider it as complete.
Please correct if my understanding is wrong.


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