Gastroenterology Coding Alert

Question: A patient complains of pain in swallowing, acidity and regurgitation at times. Suspecting an esophageal abnormality or tumor, the provider goes on to inspect the patient upper GI tract using a flexible endoscope. Simultaneously he also carries out a high frequency transendoscopic ultrasound exam and fine needle aspiration to collect fluid sample. How do we code this scenario? Can I report 43237 or 43240?

Kansas Subscriber

Answer: Your provider performed Esophagogastroduodenoscopy of the upper GI tract using a flexible endoscope, along with an ultrasound and fine needle aspiration.

While 43237 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) would cover only the ultrasound part, 43240 (Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst [includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed]) is specific to drainage of pseudocyst, which is not the case here.

Instead, a better option for you is to report 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]). This single CPT^® code covers all the services your provider administered.

Don’t forget: CPT^® code 43238, like all other EGD code, has been revised in 2017 to remove the moderate sedation component that used to be inherent to this procedure until 2016. If provided, now, you will have to report administration of moderate sedation separately, based on the time duration of the sedation, using the following new codes:

• 99151 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age)
• 99152 (…patient age 5 years or older)
• +99153 (…each additional 15 minutes intraservice time [(List separately in addition to code for primary service]).