Basics of CPT code 43239
The Digestive System subsection (43200-49999) of the CPT code set series are used to report endoscopic procedures related to the examination and treatment of conditions in the esophagus, stomach, duodenum, and/or jejunum. These series of procedures are used to code for :
- esophagoscopy and upper gastrointestinal endoscopy;
- assessing donor specimen and overseeing preparation of fecal microbiota; and
- Category III codes for laparoscopic implantation of vagus nerve blocking therapy for morbid obesity.
Today, we will discuss one of the CPT code 43239 used for coding Esophagogastroduodenoscopy Procedure.
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Description of CPT code 43239
An upper gastrointestinal (UGI) endoscopic examination, also referred to as an esophagogastroduodenoscopy (EGD), is performed on the esophagus, stomach, duodenum, and/or jejunum with biopsy(s). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient.
Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum are inspected and any abnormalities are noted.
The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum where mucosal surfaces are inspected for any abnormalities. Single or multiple samples of suspect tissue are taken through the scope. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.
The physician examines the upper gastrointestinal tract for diagnostic purposes. The physician passes an endoscope through the patient’s mouth into the esophagus. The esophagus, stomach, duodenum, and sometimes the jejunum are viewed to determine if bleeding, tumors, erosions, ulcers, or other abnormalities are present. Single or multiple tissue samples from the upper gastrointestinal tract are obtained for biopsy specimens using biopsy forceps through the endoscope.
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
To report esophagogastroscopy where the duodenum is deliberately not examined (eg, judged clinically not pertinent), or because significant situations preclude such examination (eg, significant gastric retention precludes safe exam of duodenum), append modifier 52 if repeat examination is not planned, or modifier 53 if repeat examination is planned.
TOP diagnosis codes for Procedure code 43239
K29 Gastritis and duodenitis – 21.40%
K21 Gastro-esophageal reflux disease – 13.41%
K22 Other diseases of esophagus – 13.23%
K31 Other diseases of stomach and duode -10.47%
R10 Abdominal and pelvic pain – 6.16%
Coding Scenario for CPT code 43239
Question:
An esophagogastroduodenoscopy (EGD) was performed with white-light and narrowband imaging, and a cold biopsy was performed of mucosal tissue. How should this be reported?
Answer:
CPT code 43239, Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple, should be reported for the white-light and narrowband imaging used to enhance observation of the mucosal tissue during the biopsy procedure. Code 43239 is reported only once regardless of the number of biopsies performed via the cold biopsy technique during the EGD procedure.
Question:
May code 43239 (esophagogastroduodenoscopy [EGD]) be separately reported on the same date of service as code 43249?
Answer:
Yes, CPT guidelines permit the reporting of multiple endoscopy codes on the same date of service, as appropriate. Codes 43249, Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter), and 43239, Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple, should be reported with modifier 59, Distinct Procedural Service, appended because they describe distinctly different procedures. Both codes, however, include upper gastrointestinal diagnostic endoscopy service (43235), and payment adjustments should be expected for the duplicative portion.
RVU and Fees for CPT code 43239
| Non-Facility | Work | MP | PE | RVU | Total |
|---|---|---|---|---|---|
| 2.39 | 0.29 | 8.66 | 11.34 | $384.28 | |
| Facility | Work | MP | PE | RVU | Total |
| 2.39 | 0.29 | 1.38 | 4.06 | $137.58 |
Additional Code Information for CPT code 43239
PC/TC Indicator (26): 0 = Physician Service Codes
Multiple Procedures (51): 3 = Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family
Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply
Physician Supervision: 09 = Concept does not apply
Assistant Surgeon (80,82): 1 = Statutory payment restriction for assistants at surgery applies to this procedure
Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure
Team Surgery (66): 0 = Team surgeons not permitted for this procedure
Diagnostic Imaging Family: 99 = Concept does not apply
Endoscopy Base Code: 43235
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Scenario for CPT code 43239
A 62-year-old patient with abdominal pain and persistent dyspepsia undergoes esophagogastroduodenoscopy (EGD). Evaluation of the upper gastrointestinal (GI) tract is performed, and multiple biopsies are taken for histology and Helicobacter pylori (H. pylori) rapid urease test.
Preservice for CPT code 43239
Review all symptoms with the patient and determine characteristics of the dysphagia problem when it is clear there is dysphagia. Review patient’s history to assess the need for pre-procedure antibiotics. Review patient’s allergies and medications, specifically noting usage of antiplatelet or anticoagulation medications. Review patient’s laboratory studies as they relate to coagulation status and platelet count. Review patient’s X rays and other diagnostic tests.
Review the risks and benefits of the procedure with the patient. Obtain informed consent for the procedure. Verify all endoscopic equipment is available and operational and make appropriate computer entries as necessary. Position patient on the examination table. Position endoscopic equipment to provide access for the procedure. Perform a time out. Place a bite-block in patient’s mouth.
Intra service for CPT code 43239
Insert a standard flexible upper endoscope through the mouth into the oropharynx and advance through the esophagus into the proximal stomach. Insufflate the stomach with air after suctioning liquid contents. Perform an examination of the entire stomach in the forward and retroflexed positions. Advance the endoscope through the pylorus into the duodenal bulb. Inspect the duodenum circumferentially after air insufflation. Slowly withdraw the endoscope and reinspect the stomach and duodenum. Obtain endoscopically directed biopsies of abnormal tissue.
After suctioning air to deflate the stomach, withdraw the endoscope into the esophagus, allowing measurement of the squamocolumnar (SC) and gastroesophageal (GE) junction from the incisors. Assess for presence of a hiatal hernia and examine the esophageal mucosa. When indicated, obtain brushings or washings of suspicious abnormalities. Obtain photodocumentation of appropriate normal landmarks and abnormalities. At the conclusion of the procedure, withdraw the endoscope.
Post service for CPT code 43239
Complete post-procedure orders. Complete cytology forms as necessary. Complete post-procedure specimen verification and documentation and reporting for quality purposes. Review and label photographs. Generate a procedure report and forward to referral source and other appropriate parties. Enter data into the procedure registry. Assess patient for suitability to discharge from the recovery suite relative to established discharge criteria. When patient is stable for discharge, review findings and recommendations with the patient and pertinent others. Provide orders for necessary prescriptions, follow-up tests, and appointments to the patient.
Supply and Equipment codes used with Esophagogastroduodenoscopy CPT codes
SA042 pack, cleaning and disinfecting, endoscope
SA048 pack, minimum multi-specialty visit
SB001 cap, surgical
SB006 drape, non-sterile, sheet 40in x 60in
SB027 gown, staff, impervious
SB034 mask, surgical, with face shield
SB039 shoe covers, surgical
SC056 syringe 50-60ml
SD006 bite block
SD009 canister, suction
SD066 endoscopic biopsy forceps
SD067 endoscopic cytology brush
SD068 endoscopic polypectomy snare
SD132 tubing, suction, non-latex (6ft uou)
SD134 tubing, suction, non-latex (6ft) with Yankauer tip (1)
SF021 cautery, patient ground pad w-cord
SG051 gauze, non-sterile 4in x 4in
SH067 sodium chloride 0.9% inj (250-1000ml uou)
SJ010 basin, emesis
SJ016 denture cup
SJ032 lubricating jelly (K-Y) (5gm uou)
SK058 paper, photo printing (8.5 x 11)
SL035 cup, biopsy-specimen non-sterile 4oz
SM014 endoscope anti-fog solution
SM023 scrub brush (impregnated)
EQ113 electrosurgical generator, gastrocautery
EQ235 suction machine (Gomco)
ES005 endoscope disinfector, rigid or fiberoptic, w-cart
ES031 scope video system (monitor, processor, digital ca
ES087 multi-channeled flexible digital scope, esophagosc
Related CPT code for 43239
43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by
brushing or washing, when performed
43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance
43237 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the
esophagus, stomach or duodenum, and adjacent structures
43238 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or
transmural fine-needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the
esophagus, stomach or duodenum, and adjacent structures)
43239 Esophagogastroduodenoscopy, flexible, transoral; biopsy; single or multiple
43240 Esophagogastroduodenoscopy, with transmural drainage of pseudocyst (includes placement of
transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed)
43241 Esophagogastroduodenoscopy, flexible, transoral; insertion of intraluminal tube or catheter
43242
Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or
transmural fine-needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the
esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is
examined distal to the anastomosis)
43243 Esophagogastroduodenoscopy, flexible, transoral; injection sclerosis of esophageal/gastric varices
43244 Esophagogastroduodenoscopy, flexible, transoral; band ligation of esophageal/gastric varices
43245 Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s)
(eg, balloon, bougie)
43246 Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy
tube
43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)
43248 Esophagogastroduodenoscopy, flexible, transoral; insertion of guide wire followed by passage of
dilator(s) through esophagus over guide
43249 Esophagogastroduodenoscopy, flexible, transoral; transendoscopic balloon dilation of esophagus (<30
mm)
43233 Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm
diameter or larger) (includes fluoroscopic guidance, when performed)
43250 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by
hot biopsy forceps
43251 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by
snare technique
43252
Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy
43253
Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural
injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s)
(includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a
surgically altered stomach where the jejunum is examined distal to the anastomosis)
43254
Esophagogastroduodenoscopy, flexible, transoral; with EMR (endoscopic mucosal resection)
43255
Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method
43256
43256 has been deleted. To report, use 43266
43266 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and
postdilation and guide wire passage, when performed)
43257 Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower
esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease
43258
43258 has been deleted. To report, use 43270
43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s)
(includes pre- and post-dilation and guide wire passage, when performed)
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