How To Use CPT Code 43238

CPT 43238 describes the procedure of esophagogastroduodenoscopy (EGD) with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s). 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 43238?

CPT 43238 is used to describe a specific procedure called esophagogastroduodenoscopy (EGD) with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s). This procedure involves the insertion of a flexible endoscope through the mouth and into the esophagus, stomach, and duodenum. During the procedure, the healthcare provider uses ultrasound guidance to perform a fine needle aspiration or biopsy of the targeted area. This code is used to report the entire procedure, including the endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures.

2. Official Description

The official description of CPT code 43238 is: ‘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).’ It is important to note that this code should not be reported in conjunction with certain other codes, as specified in the notes.

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 pylorus into the duodenum.
3. The provider inspects the upper gastrointestinal (GI) tract and inserts a high-frequency ultrasound transducer through the endoscope to assess any abnormalities.
4. Under ultrasound guidance, the provider inserts a fine-gauge needle to obtain a fluid sample or tissue sample from the targeted area.
5. The provider may take multiple passes to ensure an appropriate specimen is obtained.
6. If necessary, the provider may also perform a biopsy using a blade, needle, or punch.
7. Once the samples are collected, the provider removes the ultrasound transducer, instruments, and scope.

4. Qualifying circumstances

CPT 43238 is used for patients who require an esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s). This procedure is typically performed to assess abnormalities in the esophagus, stomach, or duodenum, and adjacent structures. It is important to note that this code should not be reported with certain other specified codes.

5. When to use CPT code 43238

CPT code 43238 should be used when a healthcare provider performs an esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s). This code should not be used in conjunction with specific other codes, as indicated in the notes. It is important to review the documentation and ensure that the procedure meets the criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 43238, the healthcare provider must document the following information:

• Patient’s medical history and reason for the procedure
• Details of the procedure performed, including the use of ultrasound guidance and any biopsies or aspirations
• Date and duration of the procedure
• Specific structures examined using the endoscopic ultrasound
• Results of the procedure, including any abnormalities or findings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 43238, it is important to ensure that the procedure meets the criteria outlined in the code description. This includes the use of transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) and the examination of specific structures. It is also important to review the notes and avoid reporting this code in conjunction with specified other codes. Proper documentation is essential to support the claim for reimbursement.

8. Historical information

CPT code 43238 has undergone historical changes. In 2014, the code description was expanded to include the examination of the stomach or duodenum and adjacent structures using imaging guidance. The terms “transoral” and “flexible” were also added to describe the type of scope used in the procedure. It is important to stay updated on any changes or revisions to the code.

9. Examples

1. A healthcare provider performs an esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural fine needle aspiration to obtain a fluid sample from a suspected lesion in the patient’s stomach.
2. During an esophagogastroduodenoscopy, a healthcare provider uses transendoscopic ultrasound guidance to perform a transmural fine needle biopsy of a mass in the patient’s esophagus.
3. A patient undergoes an esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural fine needle aspiration to obtain a tissue sample from a suspected tumor in the duodenum.