Radiology Coding Alert

Question: Our radiologist provided radiological ultrasound assistance to two patients for esophagogastroduodenoscopy (EGD). The first patient had an esophageal tumor and our physician assisted in the EGD using EUS on the patient’s esophagus only. The second patient had a gastric ulcerating mass. How can we report services for the two procedures and how are these different?

Missouri Subscriber

Answer: For the first patient, your physician assisted the esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS) on the esophagus only. Therefore, you should report the esophagoscopy code 43231 (Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination). This code is inclusive of the ultrasound assistance.

In the second patient, as soon as the scope passes the esophagus, you can either report code 43237 (Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) or 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) for the EGD with EUS. Your physician must document the reason for examining the stomach, duodenum, liver, adrenal gland, or pancreas. 

Diagnosis code: Choose your diagnosis code based on the pathology report. Since your physician documents carcinoma of the esophagus, you can report the diagnosis code 150.9 (Malignant neoplasm of esophagus; unspecified site) to represent the first patient’s tumor. For the second patient, you submit ICD-9 code 531.9x (Gastric ulcer; unspecified as acute or chronic, without mention of hemorrhage or perforation) for the mass.

Tip: If your physician performed a FNA/biopsy on the tumor during the procedure in the first patient, you should report 43232 (Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s]).

Similarly, if the physician performed a biopsy during EGD in the second patient, you can report either 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]) or 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]).