2025 CPT code 43240
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophagogastroduodenoscopy Digestive System Feed
Esophagogastroduodenoscopy (EGD) with transmural drainage of a pseudocyst; includes placement of drainage catheters/stents and endoscopic ultrasound, if performed.
Modifiers 52 (reduced services) and 53 (discontinued procedure) may be used appropriately, as well as other modifiers as indicated by the specific circumstances of the procedure.Refer to the CPT codebook for detailed modifier application guidelines.
The medical necessity for this procedure is based on the presence of a symptomatic pseudocyst causing pain or other complications.Documentation should clearly support the need for drainage.
The gastroenterologist or surgeon inserts the endoscope, performs the ultrasound (if applicable), drains the pseudocyst, and places catheters/stents (if applicable).
In simple words: A thin, flexible tube with a camera is inserted through the mouth to view the esophagus, stomach, and small intestine. If a fluid-filled sac (pseudocyst) is found, a doctor will drain it and may place a small tube or stent to prevent it from filling again.A type of ultrasound may also be used during the procedure.
This procedure involves a flexible, transoral esophagogastroduodenoscopy to drain a pseudocyst.A flexible endoscope is passed through the mouth into the esophagus, stomach, and duodenum.The procedure includes the transmural drainage of the pseudocyst, using a needle to drain fluid, and placement of transmural drainage catheters or stents to prevent refilling, if necessary. Endoscopic ultrasound is also included if performed.
Example 1: A patient presents with abdominal pain and elevated pancreatic enzymes.EGD with endoscopic ultrasound reveals a pseudocyst on the pancreas.The physician performs transmural drainage of the pseudocyst and places a stent. Code 43240 is reported., A patient with a history of pancreatitis undergoes an EGD. During the examination, a pseudocyst is found adjacent to the stomach.The physician drains the pseudocyst using a transmural approach; no stent is placed.Code 43240 is reported., A patient undergoes an EGD for suspected gastric ulcer. During the examination, a pseudocyst is incidentally discovered.The physician performs transmural drainage and places a catheter. Code 43240 is reported. Endoscopic ultrasound was not utilized.
* Pre-procedure diagnosis and indication for the procedure.* Detailed description of the procedure performed, including the location of the pseudocyst, method of drainage, and placement of catheters or stents (if any).* Results of endoscopic ultrasound (if performed).* Pathology report if tissue samples were taken.* Post-procedure notes, including any complications.* Anesthesia documentation if applicable.
** Always refer to the most current CPT codebook and payer-specific guidelines for accurate coding and reimbursement.
- Revenue Code: P8B (Endoscopy - Upper Gastrointestinal)
- RVU: Refer to the Medicare Physician Fee Schedule (MPFS) for the most current RVU values.Note that moderate sedation, if used, must be billed separately.
- Global Days: Global period details are not specified for this code and will vary based on payer.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Refer to historical Medicare Physician Fee Schedule (MPFS) for past payment rates.
- Specialties:Gastroenterology, Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgery Center