Gastroenterology Coding Alert

Question: A patient with a gastric ulcerating mass came in for an esophagogastroduodenoscopy (EGD). The gastroenterologist performs the EGD, using endoscopic ultrasound on the gastric mass. Which codes should I report?

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Answer: You should report 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) for the EGD with endoscopic ultrasound (EUS).

Rule of thumb: If your physician doesn't examine past the esophagus, you should stick with the esophagoscopy code (43231, Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination). If he reaches the pyloric channel, however, the esophagoscopy becomes an EGD EUS (43259 or 43237, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination...). If this is the case, your gastroenterologist must have a documented reason for examining the stomach, duodenum, liver, adrenal gland, or pancreas.

Choose your diagnosis code based on the path report. Many diagnosis codes could apply to this patient such as carcinoma, gastric ulcer, endocrine tumors, or benign lesions.

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Marcella Bucknam, CPC, CCSP, CPCH, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program.