How To Use CPT Code 43242

CPT 43242 describes the procedure of esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s). 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 43242?

CPT 43242 can be used to describe the procedure of esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s). This code is used when a healthcare provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum. Under endoscopic ultrasound guidance, the provider carries out a fine needle aspiration or biopsy in or through the wall of the upper gastrointestinal tract or the jejunum distal to its anastomosis.

2. Official Description

The official description of CPT code 43242 is: ‘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).’

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. A flexible endoscope is inserted through the patient’s mouth and down the throat into the esophagus, stomach, and duodenum.
3. If the patient has had previous surgery, such as a gastric bypass, the provider also examines the jejunum beyond its surgical anastomosis with the stomach.
4. The provider inspects the upper gastrointestinal tract and inserts a high-frequency ultrasound transducer through the endoscope to examine any abnormalities.
5. Under ultrasound guidance, the provider inserts a fine-gauge needle to obtain a fluid sample consisting of cells that are aspirated from the area of a suspected lesion.
6. The provider may take several passes to obtain an appropriate specimen and may also take tissue samples for biopsy using a blade, needle, or punch.
7. These samples may be taken from the wall of the gastrointestinal tract or through the wall from tissues adjacent to the gastrointestinal tract.
8. Once the sample collection is sufficient, the provider removes the ultrasound transducer, instruments, and scope.

4. Qualifying circumstances

Patients eligible to undergo CPT 43242 are those who require an esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s). This procedure is typically performed to obtain fluid, tissue, and/or cell samples for laboratory analysis in patients with suspected lesions or abnormalities in the upper gastrointestinal tract. The patient may have a surgically altered stomach, and the jejunum may be examined distal to the anastomosis.

5. When to use CPT code 43242

CPT code 43242 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 reported in conjunction with other specific codes listed in the notes. It should also not be reported more than once per session.

6. Documentation requirements

To support a claim for CPT 43242, the healthcare provider must document the following information:

• Patient’s medical history and reason for the procedure
• Details of the procedure, including the use of endoscopic ultrasound guidance
• Date and duration of the procedure
• Specific areas of the upper gastrointestinal tract examined
• Fluid, tissue, and/or cell samples obtained
• Any additional procedures performed, such as biopsies
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43242, ensure that the procedure meets the criteria described in the official description. It should not be reported with specific other codes listed in the notes. It should also not be reported more than once per session. Consider the location and extent of the procedure to determine the appropriate code to report.

8. Historical information

CPT 43242 was added to the Current Procedural Terminology system on January 1, 2001. There have been historical changes and updates to the code, including code changes in 2004 and 2014.

9. Examples

1. A healthcare provider performs an esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural fine needle aspiration for a patient with a suspected lesion in the stomach.
2. During an esophagogastroduodenoscopy, a healthcare provider uses transendoscopic ultrasound guidance to perform a transmural fine needle biopsy in the duodenum of a patient with a surgically altered stomach.
3. A patient with a history of gastric bypass undergoes an esophagogastroduodenoscopy with transendoscopic ultrasound-guided intramural fine needle aspiration to obtain fluid samples from the jejunum distal to the anastomosis.