Upper gastroenterology coding has seen important changes since Jan 1, 2014 – particularly, esophogoscopy procedures. Separate codes have been introduced for rigid esophagoscopy and flexible esophagoscopy.
Six new procedure codes have made an entry for rigid esophagoscopy this year. However, these codes are to be used only when esophagoscopy is done via the transoral route. In 2013, there were no separate codes for rigid transoral esophagoscopy – rigid or flexible esophagoscopy were included under the same definitions. In 2014, the specificity has increased based on the route of administration of scope i.e., transoral or transnasal and on whether the scope used was flexible or rigid.
If a rigid scope was used, the following new codes may be applied for the transoral route:
43191 – Rigid transoral e1sophagoscopy, diagnostic, brushing and washing. By using rigid scopes, procedures such as submucosal injections, biopsy, foreign body removal, balloon dilation, guide wire insertion and dilation over guide wire can be performed. CPT codes from 43192 through 43196 have been created to be used for these procedures.
If a flexible scope is used, but the route of administration is transnasal, these codes may be used:
43197 – Flexible transnasal esophagoscopy, diagnostic, brushing washing.
43198 – Flexible transnasal esophagoscopy, with biopsy.
Certain terminologies with respect to esophagoscopy have been revised. For e.g. CPT code 43200 is defined as ‘flexible’ (in 2014) as against ‘rigid or flexible’ (in 2013). CPT codes from 43200 through 43232 are now termed as flexible. The other specifications of the code descriptor remain the same.
New codes for Flexible Transoral Esophagoscopy
43211 – Flexible transoral esophagoscopy, mucosal resection. Till 2014, esophageal mucosal resection was reported by using unlisted codes 43499 (unlisted procedure, esophagus).
43212 – Flexible transoral esophagoscopy, stent placement, dilation and guide wire passage.
A new concept has been introduced, flexible transoral esophagoscopy with retrograde dilation with CPT code 43213.
43214 – Flexible transoral esophagoscopy, balloon dilation, including imaging. The imaging has been included effective 2014. Till 2014, imaging if performed had to be separately reported.
43229 – Flexible transoral esophagoscopy, with ablation, dilation and guide wire passage. This code now includes balloon dilation (43220), insertion of guide wire (43226) and ablation (43228).
By Sandeep Paranjape, Clinical and Coding expert, NextServices