2025 CPT code 43242
(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 may be applicable to reflect reduced services (52), discontinued procedures (53), multiple procedures (51), or other circumstances.
The procedure is medically necessary when there is a clinical suspicion of malignancy, inflammation, or other pathology requiring tissue diagnosis in the esophagus, stomach, duodenum, or jejunum (in cases of surgically altered stomachs).
The physician is responsible for performing the EGD and using EUS to guide the FNA/biopsy procedure. This includes inserting the endoscope, performing the ultrasound examination, obtaining samples, and interpreting the results. Anesthesiology may be involved, depending on the patient's needs.
In simple words: The doctor uses a thin, flexible tube with a camera and light (endoscope) to look at the esophagus, stomach, and small intestine.Special ultrasound is used to find areas needing further examination. A very fine needle takes samples for testing, helping diagnose problems.
This CPT code encompasses flexible, transoral esophagogastroduodenoscopy (EGD) with the added component of transendoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) or biopsy.The procedure involves inserting a flexible endoscope through the mouth into the esophagus, stomach, and duodenum (or jejunum if applicable in cases of surgically altered stomach). Under EUS guidance, the physician performs FNA or biopsy(s), obtaining samples from intramural or transmural locations within the upper gastrointestinal (GI) tract or adjacent structures.The EUS examination is inclusive of the esophagus, stomach, duodenum, and/or jejunum (distal to anastomosis if relevant).
Example 1: A 55-year-old male presents with dysphagia and weight loss.EGD with EUS-guided FNA of a suspicious esophageal lesion is performed to rule out malignancy., A 60-year-old female with a history of gastric bypass surgery experiences recurrent abdominal pain. EGD with EUS-guided biopsy of the jejunum distal to the anastomosis is performed to evaluate the cause., A 70-year-old male with unexplained anemia undergoes EGD with EUS-guided FNA of a suspicious gastric submucosal lesion to assess for GI bleeding.
Complete patient history and physical examination, indication for the procedure, detailed procedural report including the location, number, and type of biopsies/FNA performed, pathology results, and any complications encountered.
** Always consult the latest CPT codebook and payer guidelines for the most accurate coding practices.The information provided is for guidance only and does not constitute medical advice.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: This information is not provided in the source data.Consult current fee schedules and RVU databases for current values.
- Global Days: This information is not explicitly stated; refer to current global surgical package guidelines.
- Payment Status: Active
- Modifier TC rule: Technical component (TC) modifier may apply, depending on the setting and billing practices. Check specific payer guidelines.
- Fee Schedule: Fee schedules vary by payer and location. Refer to relevant fee schedules for historical data.
- Specialties:Gastroenterology, Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)