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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Note:  The following article synopsis was NOT provided by the AHA. It was created by Find-A-Code/innoviHealth.

Article Overview

This premium article reviews published coding guidance affecting gastrointestinal endoscopy and ultrasound-guided biopsy procedures. It is aimed at coders, billing staff, and compliance teams who need to understand how CPT and coding-clinic guidance address procedure reporting in this setting. The discussion centers on how different biopsy-related terms are treated in the source guidance and why that distinction matters for code selection.

Why This Topic Matters

Endoscopy and biopsy combinations can be difficult to report consistently because published guidance may distinguish between similar procedure types. This article helps readers understand the scope of the clarification and the relevant coding publications involved.

What You Will Learn

  • Which published coding sources address this endoscopy and biopsy scenario
  • How the article frames the distinction among biopsy-related procedure types
  • Why the clarification is relevant to gastrointestinal endoscopy coding review
  • What general coding topics are involved in the guidance discussion

Who Should Read This

  • Medical coders
  • Coding auditors
  • Compliance staff
  • Revenue cycle teams
  • Gastroenterology billing specialists

Codes Discussed


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