CMS Pub. 100-04, ch. 12, § 30.1

A. Upper Gastrointestinal Endoscopy Including Endoscopic Ultrasound (EUS) (Code

43259)

If the person performing the original diagnostic endoscopy has access to the EUS and the

clinical situation requires an EUS, the EUS may be done at the same time. The procedure,

diagnostic and EUS, is reported under the same code, CPT 43259. This code conforms to CPT

guidelines for the indented codes. The service represented by the indented code, in this case

code 43259 for EUS, includes the service represented by the unintended code preceding the list

of indented codes. Therefore, when a diagnostic examination of the upper gastrointestinal tract

“including esophagus, stomach, and either the duodenum or jejunum as appropriate,” includes

the use of endoscopic ultrasonography, the service is reported by a single code, namely 43259.

Interpretation, whether by a radiologist or endoscopist, is reported under CPT code 76975-26.

These codes may both be reported on the same day.

B. Incomplete Colonoscopies (Codes 44388, 45378, G0105 and G0121)

An incomplete colonoscopy, e.g., the inability to advance the colonoscope to the cecum or

colon-small intestine anastomosis due to unforeseen circumstances, is billed and paid using

colonoscopy through stoma code 44388, colonoscopy code 45378, and screening colonoscopy

codes G0105 and G0121 with modifier “-53.” (Code 44388 is valid with modifier 53

beginning January 1, 2016.) The Medicare physician fee schedule database has specific values

for codes 44388-53, 45378-53, G0105-53 and G0121-53. An incomplete colonoscopy

performed prior to January 1, 2016, is paid at the same rate as a sigmoidoscopy. Beginning

January 1, 2016, Medicare will pay for the interrupted colonoscopy at a rate that is calculated

using one-half the value of the inputs for the codes.