(2022) EGD With EUS CPT Codes | Descriptions & Billing Guidelines
With the billing guidelines and CPT EGD With EUS codes below, you can learn how to bill endoscopic ultrasound (EU) during EGD (esophagogastroduodenoscopy) procedures.
What Is CPT Code 43231?
CPT 43231 covers a procedure in which a provider inserts a flexible endoscope (EGD) through the patient’s mouth and moves it into the esophagus.
Then, they insert an ultrasound transducer through this flexible endoscope and perform a EUS (endoscopic ultrasound).
Description
CPT code 43231 is described by the CPT book as: “Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination.”
Billing Guidelines
The 43231 CPT code can only be reported once per procedure.
You can not report CPT 43231 with CPT 76975, CPT 43232, CPT 43200, CPT 43198; o, CPT 43197.
What Is CPT Code 43232?
CPT 43232 may be billed if a provider moves a flexible endoscope (EGD) through the patient’s throat into their esophagus.
Then, the provider uses ultrasound guidance (EUS) for transmural or intramural fine needle aspiration or biopsy of the esophagus.
Description
The CPT book describes 43232 as follows: “Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s).”
Billing Guidelines
Bill CPT code 43232 only once per session, and do not bill this code with CPT 76975, CPT 76942, CPT 43231, CPT 43200, CPT 43198, or CPT 43197.
What Is CPT Code 43237?
The 43237 CPT code may be billed if a provider inserted a flexible endoscope (EGD) into the patient’s mouth and moved it through the esophagus, stomach, and duodenum.
Then, they insert an ultrasound transducer through the flexible endoscope and use ultrasound guidance (EUS) to examine the esophagus, stomach, duodenum, and adjacent tissues.
Description
The CPT book describes 43237 as follows: “Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures.”
Billing Guidelines
CPT 43237 can only be billed once per session.
43237 can not be billed with CPT 76975, CPT 44379, CPT 44378, CPT 44377, CPT 44376, CPT 44373, CPT 44372, CPT 44370, CPT 44369, CPT 44365, CPT 44364, CPT 44363, CPT 44361, CPT 44360, CPT 43259, CPT 43253, CPT 43242, CPT 43238, CPT 43235, CPT 43198; or CPT 43197.
What Is CPT Code 43238?
CPT 43238 can be billed when an EGD procedure is performed in which a provider inserts a flexible endoscope into the patient’s mouth and through the throat and into the esophagus, stomach, and duodenum.
Then, the provider performs an ultrasound-guided (EUS) transmural or intramural fine needle aspiration or biopsy of the patient’s esophagus, stomach, duodenum, and adjacent structures.
Description
The CPT book describes 43238 as follows: “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).”
Billing Guidelines
The 43238 CPT code can not be billed more than once per procedure.
Do not bill 43238 in combination with CPT 76975, CPT 76942, CPT 44379, CPT 44378, CPT 44377, CPT 44376, CPT 44373, CPT 44372, CPT 44370, CPT 44369, CPT 44366, CPT 44365, CPT 44364, CPT 44360, CPT 44361, CPT 43242, CPT 43237, CPT 43235, CPT 43198, or CPT 43197.
What Is CPT Code 43242?
43242 can be billed if the provider moves a flexible endoscope through the patient’s mouth (transoral) into the esophagus, stomach, and duodenum.
Then, the provider uses the endoscope to insert an ultrasound transducer and performs, under endoscopic ultrasound guidance (EUS), fine needle aspiration or biopsy in or through the patient’s jejunum distal or upper GI tract to the anastomosis for altering the patient’s stomach surgically.
Description
The CPT book describes CPT code 43242 as follows: “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).”
Billing Guidelines
The 43242 CPT code can only be used once per session.
You can not bill CPT 43242 in combination with CPT 76975, CPT 76942, CPT 44379, CPT 44378, CPT 44377, CPT 44376, CPT 44373, CPT 44372, CPT 44370, CPT 44369, CPT 44366, CPT 44365, CPT 44364, CPT 44361, CPT 44360, CPT 43259, CPT 43240, CPT 43238, CPT 43237, CPT 43235, CPT 43198, or CPT 43197.
What Is CPT Code 43259?
CPT 43259 can be used for an esophagogastroduodenoscopy procedure to examine the patient’s esophagus, stomach, and duodenum.
The provider starts this procedure by moving a flexible endoscope transorally into the esophagus, stomach, and duodenum and performing an endoscopic ultrasound (EUS) to examine the patient.
Description
The CPT book describes 43259 as follows: “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.”
Billing Guidelines
CPT 43259 can not be billed more than once per session.
You can not report CPT code 43259 with 76975, 44379, 44378, 44377, 44373, 44372, 44370, 44369, 44366, 44365, 44364, 44363, 44361, 44360, 43253, 43242, 43240, 43237, 43235, 43198, or CPT 43197.
References
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3368CP.pdf
https://www.aapc.com/blog/30937-no-stress-eus/
