How To Use CPT Code 43237

CPT 43237 describes the procedure of esophagogastroduodenoscopy (EGD) with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43237?

CPT 43237 is used to describe the procedure of esophagogastroduodenoscopy (EGD) with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures. This code is used when a healthcare provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum, while also inserting an ultrasound transducer through the scope to examine these same structures and adjacent tissues.

2. Official Description

The official description of CPT code 43237 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures. Do not report 43237 in conjunction with 43197, 43198, 43235, 43238, 43242, 43253, 43259, 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373, 44376, 44377, 44378, 44379, 76975. Do not report 43237 more than once per session.’

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. A flexible endoscope is inserted through the patient’s mouth and passed through the throat to the duodenum.
3. The healthcare provider visualizes the esophagus, stomach, and duodenum for any abnormalities.
4. An ultrasound examination (endoscopic ultrasound or EUS) is performed to evaluate the esophagus, stomach, or duodenum, as well as nearby tissues for abnormalities or staging of a tumor.
5. Once the procedure is complete, the scope and ultrasound transducer are removed.

4. Qualifying circumstances

CPT 43237 is performed on patients who require an esophagogastroduodenoscopy with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures. It is important to note that this code should not be reported in conjunction with other specific codes listed in the official description. Additionally, CPT 43237 should not be reported more than once per session.

5. When to use CPT code 43237

CPT code 43237 should be used when a healthcare provider performs an esophagogastroduodenoscopy with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures. It is important to follow the guidelines provided in the official description and avoid reporting this code with other specific codes listed.

6. Documentation requirements

To support a claim for CPT 43237, the healthcare provider must document the following information:

• Patient’s diagnosis and the medical necessity for the procedure
• Details of the procedure performed, including the use of a flexible endoscope and ultrasound transducer
• Date and duration of the procedure
• Findings and any abnormalities observed during the examination
• Any additional relevant information or complications encountered during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43237, ensure that the procedure meets the criteria outlined in the official description. It is important to avoid reporting this code in conjunction with other specific codes listed. Additionally, CPT 43237 should not be reported more than once per session.

8. Historical information

CPT 43237 was added to the Current Procedural Terminology system on January 1, 2004. The code was later updated on January 1, 2014, to include expanded structures that can be examined using imaging guidance.

9. Examples

1. A gastroenterologist performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to evaluate a patient with suspected esophageal cancer.
2. An oncologist performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to stage a tumor in the stomach.
3. A surgeon performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to assess the extent of a pancreatic mass.
4. A gastroenterologist performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to evaluate a patient with chronic abdominal pain.
5. An interventional radiologist performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to guide the placement of a drainage catheter in a patient with a pancreatic pseudocyst.
6. A gastroenterologist performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to assess the response to treatment in a patient with Barrett’s esophagus.
7. A surgeon performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to evaluate a patient with suspected gastric lymphoma.
8. An oncologist performing an esophagogastroduodenoscopy with endoscopic ultrasound examination to assess the response to chemotherapy in a patient with esophageal cancer.