2025 CPT code 43259
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Digestive System - Endoscopy Procedures on the Esophagus Surgery Feed
Esophagogastroduodenoscopy with endoscopic ultrasound (EGD with EUS) examines the esophagus, stomach, and duodenum (or a surgically altered stomach where the jejunum is examined distally to the anastomosis) using a flexible endoscope and ultrasound.
Modifiers may be applied depending on the circumstances of the procedure.For example, modifier -52 (reduced services) may be applied if the duodenum is not examined due to clinical reasons; modifier -53 (discontinued procedure) may apply if the procedure is stopped before completion.Consult current modifier guidelines for details.
Medical necessity for an EGD with EUS is established by the presence of symptoms or findings suggesting pathology in the esophagus, stomach, or duodenum (or the surgically altered stomach and jejunum).Examples include unexplained dysphagia, persistent GERD symptoms, abnormal findings on prior imaging studies, and post-surgical complications.The need for the EUS component is justified when additional information beyond standard endoscopy is required for diagnosis or treatment planning.
The physician administers anesthesia (if necessary), inserts the endoscope, navigates it through the esophagus, stomach, and duodenum (or modified stomach and jejunum), performs the endoscopic ultrasound examination, interprets the images, and removes the instruments.The physician assesses for any abnormalities and may take biopsies if indicated.
- Surgery
- Surgery > Surgical Procedures on the Digestive System > Surgical Procedures on the Esophagus > Endoscopy Procedures on the Esophagus
In simple words: This procedure uses a thin, flexible tube with a camera on the end (passed through the mouth) to view the esophagus, stomach, and the first part of the small intestine.An ultrasound is also used to get detailed images of these areas.
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. This procedure involves inserting a flexible endoscope through the mouth to visualize the esophagus, stomach, and duodenum (or a modified stomach post-surgery where the jejunum is examined beyond the surgical connection).Endoscopic ultrasound (EUS) is used to further evaluate the structures and surrounding tissues.
Example 1: A patient presents with dysphagia (difficulty swallowing).The physician performs an EGD with EUS to assess for esophageal strictures, tumors, or other causes of dysphagia. The EUS allows for precise evaluation of the esophageal wall layers., A patient with a history of gastroesophageal reflux disease (GERD) and persistent symptoms undergoes an EGD with EUS to evaluate for esophageal inflammation, Barrett's esophagus, or hiatal hernia. The EUS helps assess the depth of the inflammation or any associated abnormalities., A patient post-gastric bypass surgery experiences recurrent abdominal pain and vomiting. An EGD with EUS is performed to assess the integrity of the anastomosis (surgical connection) and to evaluate for any obstruction or leak in the jejunum distal to the anastomosis.
* Detailed history and physical examination, including the patient's symptoms and medical history.* Indication for the procedure (e.g., dysphagia, GERD, post-surgical complications).* Operative report detailing the procedure performed, findings, and any biopsies taken.* Pathology report (if biopsies were performed).* Images from the endoscopic ultrasound examination.* Anesthesia records (if applicable).
** The description includes examination of a surgically altered stomach with jejunal examination distal to the anastomosis, reflecting common post-bariatric surgery scenarios.Precise documentation of the structures examined and the findings is critical for accurate coding.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier does not apply to this code.This code typically encompasses both the professional (physician) and technical (facility) components.
- Specialties:Gastroenterology, Surgical Oncology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)