Gastroenterology Coding Alert

Question: What are the proper codes for endoscopic ultrasound (EUS) during an esophagogastroduodenoscopy (EGD)?



California Subscriber

Answer: Four codes describe EUS with EGD:

- 43237--Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus for EUS without biopsy

- 43238--... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus) for EUS-guided biopsy

- 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) for EUS-guided biopsy

- 43259--... with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate for EUS without biopsy. 
 
You should choose the correct code depending on the area the gastroenterologist examines using EUS.

For examination of the esophagus only, you should report 43237 or, for a similar procedure with biopsy, 43238.

For instance: The gastroenterologist may use EUS only on the esophagus during an EGD when the patient has esophageal or mediastinum tumors, particularly if there is a stricture preventing insertion to the stomach. In this case, even if the physician can pass the instrument lower, he would not necessarily have any indications that make it necessary to use the ultrasound beyond the esophagus.

Coding scenario: The gastroenterologist sees a patient with an esophageal tumor in the endoscopy suite for an EGD. The gastroenterologist performs the EGD using EUS on the patient's esophagus only. On the claim, you should:

- report 43237 for the EGD with endoscopic EUS
- attach ICD-9 code 150.9 (Malignant neoplasm of esophagus, unspecified) to represent the patient's tumor.

If the physician uses the EUS all the way to the stomach or intestine, you should report 43242 (with fine needle biopsy) or 43259 (without biopsy). This may occur if the physician is looking for gastric ulcers, tumors, duodenal masses, strictures, pancreatic mass, pancreatic pseudocyst or ampullary (major papilla) masses, for example.

Example: A patient with a gastric ulcerating mass meets the gastroenterologist in the endoscopic suite for an EGD. The gastroenterologist performs the EGD, using EUS on the gastric mass. On the claim, you should:

- report 43259 for the EGD with EUS
- attach ICD-9 code 531.9x (Gastric ulcer; unspecified as acute or chronic, without mention of hemorrhage or perforation).