# Upper EUS with removal by hot snare



## Janelle926 (Sep 14, 2011)

What CPT code do i use to bill:
Endosonographic Finding:
A heterogenous mucosal pedunculated polypoid lesion was identified endosonographically in the antrum of the stomach. it measured 10mm.  The endosonographic borders were well-defined. The lesion involved the mucosa and submucosa. There was no involvement of the muscularis propria. The polyp was removed with a hot snare. Resection and retrieval were complete.   

Code 43242 - is the EUS with biopsy not the snare
and 
Code 43251 - is the EGD with removal by snare but does not include the ultrasound

Please help thank you!!


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## bridgettemartin (Sep 15, 2011)

43242 is the code for an EUS with fine needle aspiration.
There is no code for an EUS/biopsy, or an EUS/Snare.  So, if the Dr. performed an upper EUS in addition to the EGD/snare, then you would use 43259 and 43251 with the appropriate modifer.
Bridgette Martin LPN, CPC, CGIC


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## JDV7980 (Mar 22, 2012)

wouldn't 43242 be considered EUS with biopsy also?  CPT states "fine needle aspiration/biopsy(s)".  doesn’t the forward slash mean “or” in this instance?  

I have always seen the 43242 as EUS w/ FNA only also.  When my physician would perform a bx during EUS I would code EGD w/ EUS (43259) & EGD w/ bx (43239) with modifier 59 but still I would get denials so I was looking at the lay description in EncoderPro and this is what I found…

Lay Descriptions - 43242 
The physician examines the upper gastrointestinal tract and performs transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy. The physician passes an endoscope through the patient's mouth into the esophagus. The esophagus, stomach, duodenum, and sometimes the jejunum are viewed. The endoscope may be removed. A radial scanning echoendoscope is inserted and ultrasound scanning is performed to examine the esophagus, stomach, and the duodenum and/or jejunum; or an ultrasound probe is passed through the already placed endoscope. The site for a fine needle aspiration biopsy is determined. If a radial scanning echoendoscope is used, it is removed and replaced with a curvilinear array echoendoscope. The echoendoscope or ultrasound probe is fitted with a water-filled balloon near the tip; the tip contains a transducer that picks up the ultrasound frequency and relays it to a processor, outside of the body. The water-filled tip is positioned in the esophagus, stomach, or small intestine against the tissue wall next to the predetermined fine needle aspiration (FNA) biopsy site. The area is scanned and an ultrasound image is projected through the processor to a monitor in real-time. *The needle is passed through the scope to the biopsy site and a biopsy is taken of the tissue or the needle is inserted *through the wall of the esophagus, stomach, or small intestine and into a lesion or other structure, such as a lymph node. The area is biopsied. When the FNA/biopsy is complete, the instruments are removed. 

Coding Tips - 43242 Moderate sedation performed with 43242 is considered to be an integral part of the procedure and is not reported separately. However, anesthesia services (00100-01999) may be billed separately when performed by a physician (or other qualified provider) other than the physician performing the procedure. Do not report 76942 or 76975 in conjunction with this procedure. *For transendoscopic fine needle aspiration (FNA) and/or biopsy *limited to the esophagus, see 43238. For interpretation of specimen, see 88172-88173.  

So couldn't the 43242 be used for EGD w/ EUS plus Bx? Any help with coding this type of scenario would be appreciated…

thanks,
Darlene Fernandez CPC


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## bridgettemartin (Mar 23, 2012)

I read again the orginal question posed. It referred to an EUS with a snare polypectomy removal.  In my statement about there not being a code for EUS/BX, I was referring to if an EUS was done of one lesion, and then a DIFFERENT site was biopsied (Something our MD's do all the time).  If in this case, the polyp that was viewed by EUS, was then biopsied instead of snared, then 43242 could be an appropriate choice.  But in this case, it was snared, so I still think 43259/43251-51 would be appropriate.  Thanks for posting about the 43242 definition.  Like you, I had never really considered an FNA could also be a biopsy.  I'm curious if others are running into this "snare" scenario and how they are coding it as well.  Maybe I need to rethink my process.


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## JDV7980 (Mar 23, 2012)

I think you are right about the EUS w/ snare, that is how I would code it also and yes, the original question was for snare removal with EUS.  I thought since we were already kind of on the subject I would just get that in 

I asked a few other coders here where I work and they said they feel as though the "fine needle aspiration/biopsy(s)" statement in CPT means that the type of biopsy taken was with fine needle aspiration.   As stated before I have always thought the same way but then after looking at the descriptions and coding tips it made me wonder. 

Even in the workshops and update coding classes I have been in, they teach the same thing, just EUS w/ FNA.  I wonder also how others are coding the scenarios...


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## bridgettemartin (Mar 23, 2012)

I know what you mean Darlene.  I will have a thought process about something, and then I take a look at it again and wonder if I interpreted it right the first time!  Sometimes I am absolutley positive about something until someone else sheds a new light!


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