AHA Coding Clinic® for HCPCS - 2024 Issue 2; Clarification

Clarification: EUS with core-needle biopsy and EGD with biopsies of separate lesion

Coding Clinic for HCPCS Third Quarter 2021 page 12, advised to report CPT code 43238, Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures), for an endoscopic ultrasound (EUS) core-needle biopsy of the pancreas and EGD with biopsies. CPT Assistant April 2019, page 5 indicates that CPT makes a distinction between fine needle aspiration (FNA) and FNA biopsies. It appears the code descriptor of CPT code 43238 is intended for FNA biopsies as opposed to fine-needle aspirations alone or other types of biopsies. In addition, CPT Assistant March 2019, page 10 indicates that FNA biopsy codes are distinctly different from, and do not apply to core-needle biopsies. Based on this information, it seems that CPT code 43238 does not apply to core-needle biopsies. We are asking Coding Clinic for HCPCS to revisit the Third Quarter 2021 advice. ...

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