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Endoscopic Ultrasound Questions

Selina Posted Thu 09th of January, 2020 22:28:48 PM
Hello, First case: Patient was scheduled for a lower EUS but due to anatomy, they were unable to reach area to do EUS so he billed it as a flex sig w/bx 45331 and 45335 submucosal injection. Would this be correct or should 45341 with incomplete modifier 53 also be included? Second case: EUS w/FNA (43238), but the doctor specified that no EGD was done. Is there a code for just an EUS with no EGD or is 43238 appropriate?
SuperCoder Answered Fri 10th of January, 2020 06:40:20 AM

Hi Selina,

 

Thanks for your question.

 

Based on the limited documentation, we can suggest you the following: 

 

In first case, if ultrasound was not performed, then you should not report codes 45331 and/or 45335 because documentation has not mentioned anything about biopsy or submucosal injection. Instead, you may report code 45330 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) since ultrasound was not performed.

 

In second case, when EGD was not done, code 43238 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ul ) cannot be reported. If it was a gastrointestinal endoscopic ultrasound, then you may report code 76975 (Gastrointestinal endoscopic ultrasound, supervision and interpretation)

 

Please check your documentation carefully. Please feel free to write if you have any question.

 

Thanks

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