Gastroenterology Coding Alert

Question: A patient presented to our practice for suspected esophageal cancer or abnormality. The gastroenterologist inspected the upper GI tract with a flexible endoscope using high frequency transendoscopic ultrasound and extracting fine needle aspirates at three sites. Should we report 43237 or 43240?

Georgia Subscriber

Answer: Neither code you suggest is the best choice for this case. The best code that captures the entire esophagogastroduodenoscopy (EGD) procedure you describe is 43238 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures)).

The codes you suggest are less specific to describe your surgeon’s work. Code 43237 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) would cover only the ultrasound part of the encounter. On the other hand, 43240 (Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed)) is specific to drainage of pseudocyst, which is not the case in your question.