The following coding examples provide a spectrum of common clinical circumstances that cover the use of EUS codes. It is most important to note what you can and can’t code as part of the same procedure. When EUS codes were new, there was limited reporting allowed of a separate 76975 code (GI EUS supervision & interpretation), or 76942 (US guidance for needle placement, supervision & interpretation). However, CPT revisions and clarifications, and CCI edits, now consider the work bundled into the EUS codes themselves, so these codes are not separately reportable. Also, although EUS-guided celiac plexus neurolysis does not have a distinct code, 64680 Destruction by neurolytic agent, with or without radiologic monitoring, celiac plexus can be used in conjunction with 43259 to describe the procedure. 43242 may be used with 64680 if a fine needle aspiration is performed during the same procedure.
Coding example - pancreas carcinoma staging with EUS A 58-year-old male with painless jaundice is referred for EUS to evaluate for a pancreas mass.
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CPT
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Modifier
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ICD-9
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43259 Endoscopic Ultrasound
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Primary malignant neoplasm of pancreas head, 157.0
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Coding example - esophageal carcinoma staging with EUS
A 75-year-old male with esophageal carcinoma is referred for EUS. At the time of the exam balloon dilation of the esophageal tumor and subsequent EUS FNA of a celiac lymph node are performed.
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CPT
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Modifier
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ICD-9
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43242 EGD with EUS FNA
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Esophageal cancer 150.5
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43249 EGD with balloon dilation of esophagus (<30 mm diameter)
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51
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Dysphagia 787.2
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NOTE: CCI edits preclude reporting 43249 with similar EuS code 43232
Coding example - mediastinal lymph node biopsy with EUS
A 67-year-old male with mediastinal lymphadenopathy on chest CT is referred for EUS FNA. At the time of the EUS a subcarinal lymph node is biopsied.
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CPT
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Modifier
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ICD-9
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43232 Esophagoscopy with EUS FNA
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Malignant neoplasm of bronchus and lung, unspecified 162.9
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or
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43242 EGD with EUS FNA
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Note that if the echoendoscope is advanced beyond the esophagus then the appropriate code is 43242. However, if the exam is confined to the esophagus, then 43232 should be used.
Coding example - rectal carcinoma staging and lymph node biopsy
A 53-year-old male with hematochezia and anemia is identified to have a rectal adenocarcinoma at colonoscopy. He is referred for rectal endoscopic US. At the time of the exam, perirectal lymph nodes are found and undergo EUS FNA.
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CPT
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Modifier
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ICD-9
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45342 Flexible sigmoidoscopy with EUS FNA
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Malignant neoplasm, rectum, 154.1
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Coding example - pancreas carcinoma staging with biopsy and celiac plexus neurolysis
A 53-year-old female has a pancreas head mass that you are asked to stage, and if unresectable, biopsy and perform a celiac plexus neurolysis. During the exam, you employ Doppler imaging to assist with vessel identification and verify normal flow.
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CPT
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Modifier
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ICD-9
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43242 EGD with EUS FNA
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Malignant primary neoplasm, pancreas head, 157.0
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64680 Cellac Plexus Neurolysis
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51
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Abdominal pain, epigastric, 789.06
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Coding example - gastric submucosal mass evaluation with EUS
A 33-year-old female is referred to further evaluate a small gastric submucosal mass. You perform the entire procedure with a standard gastroscope and US catheter.
43259 Endoscopic ultrasound
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CPT
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Modifier
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ICD-9
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43259 EGD with EUS
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211.1
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DISCLAIMER:
The American Society for Gastrointestinal Endoscopy (ASGE) has made reasonable efforts to confirm the accuracy of the information provided but this advice is intended only to provide a broad overview of coding and coverage. The information is not intended to serve as specific advice about how to utilize, code, bill or charge for any medical product or services. Clinical scenarios, non-clinical circumstances, individual payer policies and numerous other factors may impact a particular situation. ASGE makes no representation or warranty regarding the completeness or accuracy of the information.