How To Use CPT Code 43239

CPT 43239 describes a specific procedure known as esophagogastroduodenoscopy (EGD) with biopsy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43239?

CPT 43239 is used to report the procedure of esophagogastroduodenoscopy (EGD) with biopsy. This involves the insertion of a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum to obtain one or more tissue biopsy specimens for diagnostic analysis.

2. Official Description

The official description of CPT code 43239 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple.’ It is important to note that CPT 43239 should not be reported in conjunction with CPT 43254 for the same lesion, or with codes 43197, 43198, 43235, 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373, 44376, 44377, 44378, or 44379.

3. Procedure

1. The provider administers anesthesia to the patient.
2. A flexible endoscope is inserted through the patient’s mouth and passed through the esophagus, stomach, and pylorus into the duodenum.
3. The physician inspects the upper gastrointestinal (GI) tract for any abnormalities.
4. If necessary, the physician uses biopsy forceps to remove one or more tissue biopsy specimens for diagnostic analysis.

4. Qualifying circumstances

CPT 43239 is used when a patient undergoes esophagogastroduodenoscopy (EGD) with biopsy. This procedure is typically performed to diagnose or evaluate conditions affecting the upper GI tract, such as ulcers, inflammation, tumors, or other abnormalities. It is important to note that CPT 43239 should not be reported in conjunction with certain other codes, as mentioned in the official description.

5. When to use CPT code 43239

CPT code 43239 should be used when a provider performs esophagogastroduodenoscopy (EGD) with biopsy. This code should not be used for the same lesion as CPT code 43254, and should not be reported with certain other codes as specified in the official description.

6. Documentation requirements

To support a claim for CPT code 43239, the provider must document the following information:

• Patient’s diagnosis or reason for the procedure
• Details of the procedure, including the use of a flexible endoscope and the specific areas of the upper GI tract examined
• Number of tissue biopsy specimens obtained
• Any additional findings or abnormalities observed during the procedure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 43239, it is important to ensure that the procedure meets the criteria outlined in the official description. Additionally, CPT code 43239 should not be reported in conjunction with certain other codes, as specified. It is recommended to review the specific billing guidelines and requirements of the payer to ensure accurate and appropriate reporting of CPT code 43239.

8. Historical information

CPT code 43239 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2014, when it was combined with several terms to describe the procedure of esophagogastroduodenoscopy (EGD) and the term “transoral” was added to indicate the route of insertion through the mouth.

9. Examples

1. A patient undergoes esophagogastroduodenoscopy (EGD) with biopsy to evaluate persistent abdominal pain and rule out any abnormalities in the upper GI tract.
2. A provider performs esophagogastroduodenoscopy (EGD) with biopsy on a patient with a history of gastric ulcers to monitor the healing process and assess for any signs of recurrence.
3. During an esophagogastroduodenoscopy (EGD) with biopsy, a physician identifies an abnormal growth in the stomach and obtains tissue samples for further analysis and diagnosis.
4. A patient with chronic acid reflux undergoes esophagogastroduodenoscopy (EGD) with biopsy to assess the extent of damage to the esophagus and determine the appropriate treatment plan.
5. As part of a diagnostic workup, a provider performs esophagogastroduodenoscopy (EGD) with biopsy on a patient with unexplained weight loss and gastrointestinal symptoms to investigate potential underlying causes.
6. A patient with a family history of gastric cancer undergoes esophagogastroduodenoscopy (EGD) with biopsy as a preventive measure to screen for any early signs of malignancy.
7. During an esophagogastroduodenoscopy (EGD) with biopsy, a physician identifies areas of inflammation in the esophagus and obtains tissue samples to determine the underlying cause and guide treatment.