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43237 vs. 43259

Sophie Posted Mon 01st of February, 2016 16:20:21 PM

I am having trouble in selecting the correct code. The descriptors for each are:

43237: Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures.
43259: 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.

The physician performed an eus stating, “The endosonoscope was introduced through the mouth and advanced to the second part of the duodenum. The upper EUS was accomplished without difficulty.” The physician was using the ultrasound to look at the pancreas. My physician did not have a patient with a surgically altered stomach. Which code would be correct here?

SuperCoder Answered Wed 03rd of February, 2016 03:12:21 AM

Hi,

CPT code 43237 will be an appropriate code for the above scenario.

Sophie Posted Thu 04th of February, 2016 17:59:54 PM

Thank you for your response. Can you explain the difference between the codes? It is correct to say that you would use 43237 when the physician scopes the stomach or the duodenum and to use 43259 when the physician scopes the stomach and the duodenum? Also, can you scope the duodenum without scoping the stomach? Don't you have to go through the stomach to get to the duodenum? Thanks for your help!

Sophie Posted Thu 04th of February, 2016 17:59:57 PM

Thank you for your response. Can you explain the difference between the codes? It is correct to say that you would use 43237 when the physician scopes the stomach or the duodenum and to use 43259 when the physician scopes the stomach and the duodenum? Also, can you scope the duodenum without scoping the stomach? Don't you have to go through the stomach to get to the duodenum? Thanks for your help!

SuperCoder Answered Fri 05th of February, 2016 08:36:51 AM

Hi,

43237 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures. An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach and duodenum by means of a flexible endoscope through the mouth hence duodenum can-not be scoped without scoping the stomach. The endosonoscope was introduced through the mouth and advanced to the second part of the duodenum hence appropriate code would be 43237.

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