Does Multiple Sites Mean Multiple Units of 43239?
Question: If a patient with eosinophilic esophagitis (EoE) presents for an esophagogastroduodenoscopy (EGD) and the gastroenterologist collects specimens at multiple biopsy sites, can we report multiple units of 43239? California Subscriber Answer: Let’s start by examining the descriptor for 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple). The descriptor itself specifies “single or multiple,” so the number of biopsy specimens does not automatically create multiple units of the EGD biopsy code. This matters in EoE because the gastroenterologist may obtain biopsies from more than one level of the esophagus. You might see documentation such as, “Biopsies obtained from the distal, mid, and proximal esophagus.” That documentation demonstrates that biopsies occurred at multiple sites, but it does not mean you should report 43239 three times. Instead, the multiple biopsy specimens remain part of the single EGD with biopsy service represented by 43239, subject to the current CPT® rules and payer requirements. The pathology service is a separate consideration. Do not assume that the number of specimens automatically determines the professional pathology coding either. Pathology coding depends on the specimens examined and the applicable pathology code definitions. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
