Gastroenterology Coding Alert

Answer: No. In this case, you should use 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]). You can use this code when the physician takes a biopsy beyond the esophagus. You’ll commonly use this code when a physician biopsies or aspirates a pancreatic pseudocyst.

 

The extent and the location of the scope determines the accurate code for upper endoscopy with ultrasound. Documentation is extremely important in assigning the appropriate codes, so you should make doubly sure by querying the physician as to the exact parts examined by him. 

 

You would have coded 43232 (Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy [s]) if your gastroenterologist would have performed an esophagoscopy for fine needle aspiration (FNA) with EUS. This may be used to aspirate or biopsy a mass of the esophagus that is suspicious for malignancy. But, if your gastroenterologist uses the endoscope (with EUS) beyond the esophagus for biopsy, then you need to switch to other codes. According to the information given by you, the GI performed the procedure to aspirate/biopsy pancreatic masses, so 43242 is justified.

 

Remember: Do not bill radiology codes 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) or 76975 (Gastrointestinal endoscopic ultrasound, supervision and interpretation) if your gastroenterologist performs EUS or EUS with FNA, as they are in the CPT® exclusion list.