Gastroenterology Coding Alert

Question: Our gastroenterologist used an endoscope with ultrasound to do a fine needle aspiration (FNA) biopsy on a suspicious mass. He went through the esophagus to get to the mass located in the stomach. Do I report this as an esophagoscopy with 43232, or is 43242 more appropriate?

Indiana Subscriber

Answer: Based on the information you provided, it looks like 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)) is the most accurate code to use. Let’s investigate why.

First, it’s important to mention that these procedures can undoubtedly get confusing. The descriptors are very similar, and the provider might examine other areas of the upper GI tract with the endoscope in addition to the site of the problem, which are all details that will dictate the correct code to use. When your gastroenterologist performs an esophagoscopy for fine needle aspiration (FNA) with endoscopic ultrasound (EUS) to aspirate or biopsy a mass that’s in the esophagus, then you would report the procedure with 43232 (Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s)).

However, if your gastroenterologist uses the endoscope (with EUS, but the mass requiring biopsy is beyond the esophagus as you described in your question, you’ll report 43242. This procedure code may be used to report the aspiration or biopsy a mass (that’s considered suspicious for malignancy) in the stomach, duodenum, and/or jejunum. It is also commonly used to report biopsies of pancreatic lesions.

There’s a third code you may also want to note for future reference, and that is 43238 (… 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)). You’ll want to report this code if your gastroenterologist performs EUS of a single region and performs an FNA biopsy of that region but uses the endoscope to visually examine the stomach and either the duodenum and/ or jejunum.