Gastroenterology Coding Alert

See how your coding options shift for EUSs with fine needle aspirations If your gastroenterologist uses upper endoscopic ultrasounds (EUS) to measure the depth of lesions, masses or tumors in the esophagus and pancreas, among other structures, then you know you need to have your EUS codes on hand. Simplify your coding options by breaking down these codes into three categories.

Keep in mind: All the codes used for endoscopic ultrasound are on the approved list for ASC procedures. 1. Examine Your Esophagus EUS Coding Options When your gastroenterologist performs an EUS on the esophagus, you’ve got two codes from which to choose.

When is EUS limited to the esophagus? The gastroenterologist may use EUS only on the esophagus during an esophagogastroduodenoscopy (EGD) when the patient has esophageal or mediastinum tumors, “particularly if there is a stricture preventing insertion to the stomach,” says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT Advisory Panel.

Limited to the esophagus: For instance, if the physician only examines the esophageal region with EUS, you should report 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination).

With EGD: Secondly, for an EGD with EUS, stick with 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate).

Don’t forget 43237 (… with endoscopic ultrasound examination limited to the esophagus) when your gastroenterologist performs an EGD and EUS in the esophagus. 

Several scenarios may demand EUS all the way to the stomach or small intestine, Weinstein says. “Generally, gastric ulcers, tumors, duodenal masses, strictures, pancreatic mass, pancreatic pseudocyst or ampullary (major papilla) masses” require EUS past the esophagus, Weinstein says.

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 the following:

• 43259 for the EGD with EUS

• 531.9x (Gastric ulcer; unspecified as acute or chronic, without mention of hemorrhage or perforation) to represent the patient’s ulcers. Be sure to attach documentation that will fortify the claim. “The report should describe the procedure performed in sufficient detail to pass any post-claim audit,” Weinstein says.

Note: You would use this same code (43259) for an EUS of the pancreas.

Rule of thumb: If your physician doesn’t examine past the esophagus, you should stick with the [...]