Outpatient Facility Coding Alert

Question: If we document the endoscopic ultrasound and supervision, can we report 76975 with all gastrointestinal endoscopic procedures other than codes 43231, 43232, 43237, 43238, 43242, 43259, 45341, and 45342?

Texas Subscriber

Answer: You’ll have to make that decision case by case.

When you report any procedure and the code descriptor says, “with endoscopic ultrasound examination” (such as the codes you listed), you should not separately report 76975 (Gastrointestinal endoscopic ultrasound, supervision and interpretation). For example, if you see the guidelines for reporting 43259 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis), which was revised slightly for 2014, it carries an instruction not to report it with 76975.

Regarding documentation, diagnostic tests require an order, and according to CPT® guidelines:

• All diagnostic ultrasound examinations require permanently recorded images with clinically indicated measurements
• A final, written report should be issued for inclusion in the patient's medical record
• Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.

Coding tip: If the surgeon performs any endoscopic procedure and uses ultrasound guidance during the procedure, it is best to look at the individual code that you will report for the procedure to see if imaging guidance is included in the procedure.