Gastroenterology Coding Alert

Question: Can we report EUS (43242) at the same time as EGD with biopsy of the stomach (43239)? Will I need a modifier on 43239?

Texas Subscriber

Answer: The National Correct Coding Initiative bundles 43239 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum or jejunum as appropriate; with biopsy, single or multiple) to 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 or jejunum as appropriate]). 
 
Therefore, under normal circumstances, if the gastroenterologist performs upper GI endoscopy with biopsy (43239) at the same time as ultrasound-guided aspiration (43238) for the same polyp, you would not report both procedures.
 
But the NCCI edit does contain a -1- modifier indicator, meaning you may use modifier 59 (Distinct procedural service) to unbundle the edit when necessary. In practice, this means that you could report both 43242 and 43239 (with modifier 59) if the GI used the two separate techniques to biopsy/aspirate two separate areas. Such cases would be rare, however.

Learn more: For more on NCCI and using modifier 59, see -6 Points You Absolutely Must Know About NCCI- on page 42.

 -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the AMA's CPT advisory panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.