Gastroenterology Coding Alert

Question: Our GI performed attended to two patients for esophagogastroduodenoscopy (EGD). The first patient had an esophageal tumor and the gastroenterologist performed the EGD using EUS on the patient’s esophagus only. The second patient had a gastric ulcerating mass. What is the difference in reporting both EGD cases?

Missouri Subscriber

Answer: In the first case, the gastroenterologist performed the EGD with endoscopic ultrasound (EUS) on the patient’s esophagus only. Therefore, you should stick with the esophagoscopy code 43231 (Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination). Choose your diagnosis code based on the path report. Many diagnosis codes could apply to this patient such as carcinoma, gastric ulcer, endocrine tumors, or benign lesions. The most common dx code could be 150.9 (Malignant neoplasm of esophagus; unspecified site) to represent the patient’s tumor.

Tip: If the GI performed a FNA/biopsy on the tumor along with the EGD, you should report 43232 (Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s])

In the second case, as soon as the scope passes the esophagus, you can either report code 43237 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) or 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) for the EGD with EUS. Your gastroenterologist must document the reason for examining the stomach, duodenum, liver, adrenal gland, or pancreas. You can attach ICD-9 code 531.9x (Gastric ulcer; unspecified as acute or chronic, without mention of hemorrhage or perforation) for the mass.

Similarly, if the physician performed a biopsy during EGD, you can report either 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]) or 43242 (Esophagogastroduodenoscopy, flexible, transoral; 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 a surgically altered stomach where the jejunum is examined distal to the anastomosis]).