The difference between 43239 and 43259
This information is from Optum Encoder Pro:
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 . Lay description:The physician uses an endoscope to examine the upper gastrointestinal tract and performs an endoscopic ultrasound examination of the esophagus, stomach, and the duodenum and/or jejunum. The physician passes an endoscope through the patient's mouth into the esophagus. The esophagus, stomach, duodenum, and sometimes the jejunum, are viewed. The endoscope may be removed and a radial scanning echoendoscope inserted or an ultrasound probe is passed through the already placed endoscope and an ultrasound examination is performed, including the esophagus, stomach, and the duodenum and/or jejunum. The echoendoscope or ultrasound probe is fitted with a water-filled balloon near the tip, which contains a transducer that picks up the ultrasound frequency and relays it to a processor outside of the body, where the internal images can be viewed on screen. When the ultrasound scanning is completed, the instruments are removed. Coding tips: This code has been revised for 2017 in the official CPT description. The moderate sedation icon has been deleted. Surgical endoscopy includes a diagnostic endoscopy; however, diagnostic endoscopy can be identified separately when performed at the same surgical session as an open procedure. When endoscopic procedures are performed, report the appropriate endoscopy of each anatomic site examined. Do not report this code more than once per encounter. Do not report 43259 with 43197, 43198, 43235, 43237, 43240, 43242, 43253, 44360, 44361, 44363-44366, 44369, 44370, 44372, 44373-44379, or 76975. For esophagogastroduodenoscopy, with removal of tumors, polyps, or lesions, by hot biopsy forceps, see 43250; by snare technique, see 43251; For esophagoscopy, flexible, with removal of tumors, polyps, or lesions, by hot biopsy forceps, see 43216; by snare technique, see 43217. Supplies used when providing this procedure may be reported with HCPCS Level II code A4270. Check with the specific payer to determine coverage.Optum 360 EndcoderPro.comProfessional.
43239-Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple. Lay description: The physician examines the upper gastrointestinal tract for diagnostic purposes. The physician passes an endoscope through the patient's mouth into the esophagus. The esophagus, stomach, duodenum, and sometimes the jejunum are viewed to determine if bleeding, tumors, erosions, ulcers, or other abnormalities are present. Single or multiple tissue samples from the upper gastrointestinal tract are obtained for biopsy specimens using biopsy forceps through the endoscope. Coding tips: This code has been revised for 2017 in the official CPT description. The moderate sedation icon has been deleted. Report the appropriate endoscopy for each anatomic site examined. Surgical endoscopy includes a diagnostic endoscopy; however, diagnostic endoscopy can be identified separately when performed at the same surgical session as an open procedure. When code 43239 is performed, do not report with 43254 if both procedures are performed on the same lesion. Do not report this code with 43197, 43198, 43235, or 44360-44379.