Gastroenterology Coding Alert

Answer: This encounter warrants the use of 43237 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures). Here’s why.

All of the codes you mentioned seem very similar, and it’s easy to confuse them. A good way to decide which to use is to assess the extent and location of the scope visualization and regions examined during the ultrasound. In the above encounter, the gastroenterologist performed an upper endoscopy, but only used the ultrasound to examine one of the regions: the esophagus.

You’d report 43231 (Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination) if the exam was limited to an esophagoscopy with endoscopic ultrasound and the physician didn’t look at any other areas. For 43259 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis), you’ll need documentation that the gastroenterologist examined the jejunal limbs of a post-gastric surgery patient.

Look carefully at the documentation to determine the correct code for the examination. As always, if there are discrepancies within the notes, check in with the gastroenterologist. Good communication between coders and providers is necessary to ensure correct coding and maximum reimbursement.