2025 CPT code 43238
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Esophagogastroduodenoscopy with transendoscopic ultrasound-guided fine needle aspiration/biopsy.
Modifiers 52 (reduced services) and 53 (discontinued procedure) are applicable if the duodenum is not examined.Other modifiers may be appropriate based on the specific circumstances.
The procedure should only be performed when clinically indicated based on patient symptoms and findings.EUS-guided FNA is used when other diagnostic approaches (e.g., upper endoscopy alone, CT scan) fail to obtain conclusive results. The procedure is medically necessary for diagnostic clarification and staging of suspected malignancy or for definitive diagnosis of other conditions.
The physician is responsible for performing the EGD, interpreting the ultrasound images, precisely guiding the needle for sampling, obtaining adequate samples, and interpreting the results.Pre-procedure patient assessment, anesthesia administration (if applicable), and post-procedure monitoring and care are additional clinical responsibilities.
In simple words: The doctor inserts a thin, flexible tube with a camera and light (endoscope) through the mouth to examine the esophagus, stomach, and duodenum.Using ultrasound, they guide a tiny needle to collect samples (tissue or fluid) for testing.
This CPT code encompasses a flexible, transoral esophagogastroduodenoscopy (EGD) with the added component of transendoscopic ultrasound (EUS)-guided, intramural or transmural fine needle aspiration (FNA) and/or biopsy(s) of the esophagus, stomach, duodenum, and adjacent structures.The procedure involves inserting a flexible endoscope through the mouth to visualize and access these areas.Under ultrasound guidance, a fine-gauge needle is used to obtain tissue or fluid samples for pathological examination.
Example 1: A patient presents with dysphagia (difficulty swallowing) and suspected esophageal cancer.EUS-FNA is performed to obtain a tissue sample for diagnosis. , A patient presents with upper gastrointestinal bleeding. EGD with EUS-FNA is used to localize and sample the bleeding site for diagnosis and potential treatment., A patient has a known pancreatic mass detected by CT scan. EUS-FNA is performed to obtain cytological samples for diagnosis and staging.
* Complete patient history and physical examination findings.* Indication for the procedure (e.g., suspected malignancy, unexplained bleeding).* Images from the endoscopy and ultrasound demonstrating the location of the lesion.* Detailed description of the sampling technique and the number of samples obtained.* Pathology report of the obtained samples.* Anesthesia record (if applicable).
** The endoscopic ultrasound examination is limited to the esophagus, stomach, duodenum, and adjacent structures.
- Revenue Code: P8B (Endoscopy - Upper Gastrointestinal)
- RVU: Information not available in provided text.Consult official RVU databases for current values.
- Global Days: Information not provided.Consult official coding guidelines for global period details.
- Payment Status: Active
- Modifier TC rule: This information is not available from the provided source. It would depend on the facility's and payer's rules, policies, and requirements.
- Fee Schedule: Information not available in provided text. Consult official fee schedules and historical records.
- Specialties:Gastroenterology, Oncology
- Place of Service:Office, Ambulatory Surgery Center, Hospital (Inpatient or Outpatient)