How To Use CPT Code 43259

CPT code 43259 describes a procedure known as esophagogastroduodenoscopy (EGD) with endoscopic ultrasound examination. 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 43259?

CPT 43259 is used to describe the esophagogastroduodenoscopy procedure, which involves the use of a flexible endoscope to view the esophagus, stomach, and duodenum. During this procedure, an endoscopic ultrasound examination is performed to evaluate and assess any abnormalities in these areas.

2. Official Description

The official description of CPT code 43259 is: ‘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.’

3. Procedure

1. After administering anesthesia, the physician inserts a flexible endoscope through the mouth.
2. The endoscope is guided through the pylorus into the duodenum and/or jejunum.
3. The physician inspects the esophagus, stomach, and duodenum for any abnormalities.
4. An endoscopic ultrasound examination, known as EUS, is performed to evaluate the esophageal wall or any esophageal tumors.
5. Once the examination is complete, the devices are removed.

4. Qualifying circumstances

CPT 43259 is used when performing an EGD with endoscopic ultrasound examination. It should not be reported in conjunction with other specific codes, as mentioned in the notes. This procedure is typically performed on patients who require a thorough evaluation of the esophagus, stomach, and duodenum, including those with suspected abnormalities or tumors.

5. When to use CPT code 43259

CPT code 43259 should be used when performing an EGD with endoscopic ultrasound examination. It is appropriate for cases where a comprehensive evaluation of the esophagus, stomach, and duodenum is necessary, including the examination of the jejunum in patients who have undergone previous bariatric surgery.

6. Documentation requirements

To support a claim for CPT 43259, the physician must document the following information:

• Reason for performing the procedure and the need for an endoscopic ultrasound examination
• Details of the examination, including the areas examined (esophagus, stomach, duodenum)
• Date and duration of the procedure
• Any abnormalities or tumors identified during the examination
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 43259, ensure that the procedure meets the criteria described in the official description. It should not be reported with specific other codes, as mentioned in the notes. It is important to follow the guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT 43259 was added to the Current Procedural Terminology system on January 1, 1994. Since then, there have been updates to the code, including changes in the terminology and the addition of coverage for patients who have undergone previous bariatric surgery.

9. Examples

1. A patient undergoes an EGD with endoscopic ultrasound examination to evaluate a suspected esophageal tumor.
2. A physician performs an EGD with endoscopic ultrasound examination to assess the extent of a gastric ulcer.
3. An individual who has undergone bariatric surgery undergoes an EGD with endoscopic ultrasound examination to evaluate the jejunum distal to the anastomosis.
4. A patient with chronic abdominal pain undergoes an EGD with endoscopic ultrasound examination to identify any abnormalities in the esophagus, stomach, or duodenum.
5. A physician performs an EGD with endoscopic ultrasound examination to evaluate a patient with suspected Barrett’s esophagus.
6. An individual with a history of esophageal cancer undergoes an EGD with endoscopic ultrasound examination for surveillance purposes.
7. A patient with unexplained weight loss undergoes an EGD with endoscopic ultrasound examination to assess the gastrointestinal tract.
8. A physician performs an EGD with endoscopic ultrasound examination to evaluate a patient with suspected pancreatic cancer.
9. An individual with a history of gastric bypass surgery undergoes an EGD with endoscopic ultrasound examination to evaluate the jejunum.
10. A patient with difficulty swallowing undergoes an EGD with endoscopic ultrasound examination to assess the esophagus for any strictures or abnormalities.