General Surgery Coding Alert

Answer: Based on the information you provide, the most appropriate code may be 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 state that the surgeon used endoscopic ultrasound (EUS) and that scope advances to the stomach, which matches the code’s definition of esophagogastroduodenoscopy (EGD) encompassing “gastric” (stomach) and duodenum (first portion of small intestine leading from the stomach). You also state that the fine needle aspiration (FNA) biopsy extraction was from the stomach, which matches 43242.

Distinguish: Based on advancing the scope to the stomach, you would not use a similar code that does not include proceeding beyond the esophagus: 43232 (Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s))

Option: But you don’t clarify that the surgeon examines all parts of the upper gastrointestinal (GI) tract, including the esophagus, stomach and duodenum in this procedure. If the documentation indicates that the surgeon focuses the exam and FNA solely on one region, you might turn to 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)).