Wiki 43237 vs. 43259

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Annes325

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The description for CPT 43237 is an EGD; with EUS limited to the esophagus, stomach or duodenum , and adjacent structures. The description for CPT 43259 is an EGD; with EUS including the esophagus, stomach, and either the duodenum or a surgically altered stomach.

Should the documentation for CPT 43259 include that the esophagus, stomach AND duodenum/surgically altered stomach was evaluated ultrasonically rather than just stating that certain area was viewed (duodenum and bile duct for example)?
 
43237
Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures

43259Esophagogastroduodenoscopy, 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

As per CPT Assistant January 2016, Volume 26, Issue 1, page 11:

43237 should be reported if the ultrasound examination is for one or two regions, not all three regions. If all three regions (or a surgically altered stomach in which the jejunum is examined distal to the anastomosis) are examined, the correct code to report is 43259.

43237 would apply if just the esophagus and/or stomach and/or jejunum distal to anastomosis were examined by endoscopic ultrasound (ie, one or two regions, but not all three).

The intent of code 43259 is to report an EGD with endoscopic ultrasound of all three regions. Codes 43259 describe a complete EGD. If there is surgically altered anatomy, the EGD would include the proximal jejunum past anastomosis.

Regards,
Dawa Tsering
 
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