Gastroenterology Coding Alert

Question: I am facing a reporting dilemma over here. My question is if a diagnostic endoscopy has been performed with an endoscopic ultrasound, how should it be reported? One of my colleagues says that both the procedures should be reported separately using a modifier, but I think only the endoscopic ultrasound should be reported. Who is correct?

Oklahoma Subscriber

Answer: According to the CPT® manual, whenever a diagnostic endoscopy has been performed along with an endoscopic ultrasound (EUS), it should be reported with the CPT® code 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).This is according to the guidelines adopted by CPT® with respect to indented codes. As these guidelines indicate, the services mentioned in the indented codes of 43259 will cover the services mentioned in the unintended code (i.e. the parent code).

Note: The endoscopist's or the radiologist's interpretation of the ultrasound can be reported under 76975 (Gastrointestinal endoscopic ultrasound, supervision and interpretation). However, the modifier 26 (Professional component) should be used along with it. Both the codes can be reported in a single day.