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Gastroenterology Coding Alert

Reader Questions:

EGD-EUS Without Biopsy? Go For 43237

Published on Thu Feb 10, 2011

Question: Let's say the gastroenterologist performs an EGD with an endoscopic ultrasound limited to the esophagus without biopsy, should I report 43231? Answer: No. Report only 43237 for this procedure. Since 2004, the Correct Coding Initiative (CCI) edits have bundled 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination) into 43237 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus). Quick fact: The gastroenterologist may use EUS only on the esophagus during an EGD when the patient has esophageal or mediastinum tumors (i.e., 150.9, Malignant neoplasm of esophagus, unspecified). Documentation: A standard report is all that is needed if an audit was performed but usually the claim is submitted without documentation.
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