Gastroenterology Coding Alert

Question: A patient complained of pain in swallowing, acidity, and regurgitation at times. Suspecting an esophageal abnormality or tumor, the provider inspected the patient’s upper GI tract using a flexible endoscope. Simultaneously he also carried out a high frequency transendoscopic ultrasound exam and fine needle aspiration to collect fluid samples. How do we code this scenario? Can I report 43237 or 43240?

Kansas Subscriber

Answer: Your provider performed esophagogastroduodenoscopy of the upper GI tract using a flexible endoscope, along with an ultrasound and fine needle aspiration.

While 43237 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) would cover only the ultrasound part, 43240 (Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed)) is specific to drainage of pseudocyst, which is not the case here.

Instead, a better option for you is to report 43238 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures)). This single CPT^® code covers all the services your provider administered and would not require you to report any additional codes to describe the ultrasound.