CPT® Code 43237

Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures

An esophagogastroduodenoscopy (EGD) is a specialized upper gastrointestinal (UGI) endoscopic examination that allows for the visualization and assessment of the esophagus, stomach, and duodenum, as well as adjacent structures. This procedure is performed using a flexible fiberoptic endoscope, which is a thin, flexible tube equipped with a light and camera. The procedure begins with the administration of an anesthetic spray to numb the mouth and throat, facilitating the insertion of the endoscope. A hollow mouthpiece is placed in the patient's mouth to keep it open during the examination. As the patient swallows, the endoscope is carefully advanced through the esophagus, allowing for direct visualization of the esophageal lining and any potential abnormalities. During the procedure, an endoscopic ultrasound (EUS) is utilized to provide a detailed examination of the esophageal wall, which is visualized as a five-layer structure. The first two layers represent the mucosa, the third layer is the submucosa, the fourth layer is the muscularis propria, and the fifth layer is the serosa or adventitia. This detailed imaging capability of EUS enhances the diagnostic accuracy of the procedure. Following the examination of the esophagus, the endoscope is advanced into the stomach, where air is insufflated to expand the stomach for better visualization. The various regions of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, are inspected for abnormalities. The endoscope is then passed through the pylorus into the duodenum and/or jejunum, where the mucosal surfaces are again examined for any irregularities. After the thorough inspection, the endoscope is withdrawn, allowing for a final assessment of the mucosal surfaces for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. The procedure coded as 43237 encompasses the complete EGD of the upper gastrointestinal tract in conjunction with the EUS examination. If additional procedures such as transendoscopic ultrasound-guided fine needle aspiration or biopsy are performed, the code 43238 should be utilized.