Gastroenterology Coding Alert

Question: My physician performed an endoscopic ultrasound on a patient to measure the depth of esophageal lesions. How should I report this?


Massachusetts Subscriber


Answer: Everything hinges on what tools your physician used and the coverage area of the ultrasound. Endoscopic ultrasounds (EUS) sport some very specific CPT codes, and finding the right one can be frustrating. 

When the physician examines only the esophagus during an EUS, you should report 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination). For a more thorough examination that goes to the duodenum with EUS, assign 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). Use the same code for an EUS of the pancreas.

Before coding this visit, be sure you know just how extensive an area the EUS covered. If the physician does not examine beyond the esophagus, use 43231. On the other hand, an esophagoscopy becomes a 43259 when the EUS reaches the pyloric channel. If the physician performed an esophagogastroduodenoscopy (EGD) with EUS limited to the esophagus, you would bill 43237 (... with endoscopic ultrasound examination limited to the esophagus).

Sigmoidoscopies also have endoscopic ultrasound codes. Your gastroenterologist may use this type of ultrasound when the patient has had fecal incontinence or scar tissue. For a flexible sigmoidoscopy with EUS, bill 45341 (Sigmoidoscopy, flexible; with endoscopic ultrasound examination).