2025 CPT code 43237
(Active) Effective Date: N/A Surgical Procedures on the Digestive System - Surgical Procedures on the Esophagus Surgery Feed
Esophagogastroduodenoscopy (EGD) with endoscopic ultrasound (EUS) examination limited to the esophagus, stomach, or duodenum, and adjacent structures.
Modifiers may be applicable in certain situations. Modifier 52 (Reduced Services) would be used if a portion of the procedure is not completed. Modifier 53 (Discontinued Procedure) would be used if the procedure is terminated due to extenuating circumstances.
Medical necessity must be established for this procedure.This may include symptoms such as dysphagia, abdominal pain, gastrointestinal bleeding, or suspected tumors.Documentation should clearly support the need for both the visual EGD and the EUS component.
The physician administers anesthesia, inserts the endoscope, performs the visual EGD and EUS examination, interprets the findings, and removes the instrument. The physician is responsible for documenting the procedure, findings, and any interventions.
In simple words: The doctor uses a thin, flexible tube with a camera and ultrasound probe to look inside your esophagus, stomach, and first part of your small intestine. The ultrasound helps create images of these organs and nearby tissues to check for problems.
This code describes a procedure where a flexible endoscope is inserted transorally (through the mouth) to perform an EGD.In addition to the visual examination of the esophagus, stomach, and duodenum, an endoscopic ultrasound (EUS) is utilized to examine either the esophagus, stomach, or duodenum, along with adjacent structures.The EUS component is limited to one of the three primary areas (esophagus, stomach, or duodenum) and does not include EUS examination of all three.
Example 1: A patient with difficulty swallowing undergoes an EGD with EUS examination of the esophagus to evaluate for a suspected esophageal tumor., A patient with upper abdominal pain and suspicion of a gastric ulcer receives an EGD with EUS of the stomach to assess the ulcer and surrounding tissue., A patient with a history of celiac disease undergoes an EGD with EUS of the duodenum and adjacent lymph nodes to evaluate for disease activity.
Documentation should include the indication for the procedure, the areas examined (esophagus, stomach, duodenum), the use of EUS and the specific area examined with EUS, findings, any interventions performed, and the post-procedure status of the patient.Any moderate (conscious) sedation should be documented and coded separately.
** As of December 1st, 2024, moderate (conscious) sedation is billed separately and should not be included in the reporting of 43237. Always refer to the latest coding guidelines and fee schedules for the most up-to-date information.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Payment Status: Active
- Specialties:Gastroenterology, General Surgery, and potentially other specialties depending on the clinical context.
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Office