Gastroenterology Coding Alert

Question: My physician performed an endoscopic ultrasound on a patient to measure the depth of lesions on the esophagus. How should I report this?

Massachusetts Subscriber Answer: Everything hinges on what tools were used and the coverage area of the ultrasound. Endoscopic ultrasounds (EUS) sport some very specific CPT codes, and finding the right one can be frustrating.
 
When the physician uses an esophagoscope for an EUS, you should report 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination). For an esophagogastroduodenoscopy with EUS, assign 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination).    Use the same code for an EUS of the pancreas.

Before coding this visit, be sure to know just how extensive an area the EUS covered. If the physician does not examine past the esophagus, use 43231. However, an esophagoscopy becomes a 43259 (Upper gastrointestinal endoscopy ...; with endoscopic ultrasound examination) when the pyloric channel has been reached.
 
To make things a little less lucid, sigmoidoscopies also have ultrasound codes. These are sometimes used when the patient has had fecal incontinence or scar tissue. For a flexible sigmoidoscopy with EUS, bill 45341 (Sigmoidoscopy, flexible; with endoscopic ultrasound examination).