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)

An esophagogastroduodenoscopy (EGD) is a specialized upper gastrointestinal (UGI) endoscopic examination that allows for the visualization and assessment of the esophagus, stomach, and duodenum. 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 a local 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. Once the endoscope is positioned beyond the cricopharyngeal region, the examination continues with the inspection of the esophagus, followed by the advancement of the endoscope into the stomach. The stomach is insufflated with air to enhance visibility, and various regions, including the cardia, fundus, greater and lesser curvature, and antrum, are thoroughly examined for abnormalities. The endoscope is then advanced through the pylorus into the duodenum and/or jejunum, where the mucosal surfaces are inspected for any signs of lesions, ulcerations, varices, or other abnormalities. In addition to the visual examination, this procedure includes an endoscopic ultrasound (EUS) component, which provides detailed imaging of the esophageal wall as a five-layer structure. This imaging capability allows for a more comprehensive assessment of the esophagus and surrounding structures. If necessary, the procedure may also involve transendoscopic ultrasound-guided fine needle aspiration or biopsy. This technique allows for the collection of tissue samples from the esophageal wall or surrounding structures, such as lymph nodes, to aid in diagnosis and treatment planning. Overall, CPT® Code 43238 encompasses both the endoscopic examination and the advanced diagnostic capabilities provided by EUS and fine needle aspiration/biopsy.