Gastroenterology Coding Alert

Question: How should we bill for the facility portion of an esophageal ultrasound (EUS) done at an ambulatory service center (ASC)? I heard that 43259/43242 and 45391/45392 are not payable at an ASC, but the charge needs to be captured somehow. Is it appropriate to bill just the 43239/45378 for the ASC portion?


Virginia Subscriber

Answer: Your information may be outdated. All of the codes used for endoscopic ultrasound are on the approved list for ASC procedures. That includes 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination) and 43232 (- with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s]).

If the ASC list doesn't include the procedure, then Medicare does not cover the procedure, and you cannot bill the patient for it either. The center will have to write it off.

Codes 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), 43242 (... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s] [includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum and/or jejunum as appropriate), 45391 (Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound examination) and 45392 (... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s]) are all on the ASC list.

CMS updates the list of approved procedures for ASCs annually, and the agency plans a large update to the list for 2008.

Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, an independent coding consultant in Marietta, Ga.