Coding Ahead
CasePilot
Medical Coding Assistant
Case2Code
Search and Code Lookup Tool
RedactPHI
HIPAA-Compliant PHI Redaction
DetectICD10CM
ICD-10-CM Code Detection
Log in Register free account
1 code page views remaining. Guest accounts are limited to 1 page view. Register free account to get 5 more views.
Log in Register free account

Official Description

Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A flexible transnasal esophagoscopy is a diagnostic procedure that involves the use of a flexible endoscope to visualize the esophagus. This procedure is performed by introducing the endoscope through the patient's nose, allowing for a direct view of the esophagus without the need for oral insertion. During the examination, various anatomical structures are assessed, including the velopharyngeal closure, the base of the tongue, and the hypopharynx. The motion of the vocal cords is also observed, and the pharyngeal musculature is evaluated for any abnormalities. As the endoscope is advanced to the cricopharyngeus, the patient may be instructed to burp or swallow, which aids in the smooth passage of the scope into the esophagus. The procedure allows for a thorough examination of the entire length of the esophagus, extending to the gastroesophageal junction. Any abnormalities detected during the procedure are carefully noted. Additionally, if necessary, tissue samples can be collected through brushing or by washing saline fluid into the esophagus, which is then retrieved for further analysis. This procedure is classified as a separate procedure, emphasizing its diagnostic nature and the specific techniques employed during the examination.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The flexible transnasal esophagoscopy is indicated for various diagnostic purposes, particularly when there is a need to evaluate the esophagus and surrounding structures. The following conditions may warrant this procedure:

  • Evaluation of Esophageal Abnormalities This procedure is performed to investigate any suspected abnormalities within the esophagus, such as strictures, lesions, or tumors.
  • Assessment of Symptoms It is indicated for patients presenting with symptoms such as dysphagia (difficulty swallowing), odynophagia (painful swallowing), or unexplained weight loss.
  • Monitoring of Known Conditions The procedure may be used to monitor patients with known esophageal conditions, such as gastroesophageal reflux disease (GERD) or Barrett's esophagus.
  • Collection of Specimens When there is a need to obtain tissue samples for histological examination, brushing or washing techniques can be employed during the procedure.

2. Procedure

The flexible transnasal esophagoscopy procedure involves several key steps to ensure a thorough examination of the esophagus:

  • Step 1: Preparation The patient is positioned comfortably, and local anesthesia may be administered to minimize discomfort during the procedure. The flexible endoscope is prepared for insertion.
  • Step 2: Insertion of the Endoscope The flexible endoscope is gently introduced through the patient's nostril. Care is taken to navigate the nasal passages without causing trauma.
  • Step 3: Advancement to the Esophagus The endoscope is advanced through the nasopharynx and into the esophagus. The clinician observes the velopharyngeal closure, base of the tongue, and hypopharynx during this phase.
  • Step 4: Vocal Cord Observation As the endoscope reaches the vocal cords, the motion of the vocal cords is assessed to evaluate their function.
  • Step 5: Evaluation of Pharyngeal Musculature The pharyngeal musculature is examined for any abnormalities that may affect swallowing or airway function.
  • Step 6: Passage through the Cricopharyngeus When the endoscope reaches the cricopharyngeus, the patient may be asked to burp or swallow to facilitate the passage of the scope into the esophagus.
  • Step 7: Examination of the Esophagus The endoscope is advanced along the entire length of the esophagus to the gastroesophageal junction, where any abnormalities are noted.
  • Step 8: Specimen Collection (if applicable) If necessary, tissue samples can be collected by brushing or washing saline fluid into the esophagus, which is then retrieved for analysis.
  • Step 9: Withdrawal of the Endoscope After the examination is complete, the endoscope is carefully withdrawn, and the entire circumference of the esophagus is visually inspected during withdrawal.

3. Post-Procedure

After the flexible transnasal esophagoscopy, patients may experience mild discomfort or a sore throat, which typically resolves quickly. It is important for patients to follow any post-procedure instructions provided by the healthcare provider, which may include dietary modifications or monitoring for any unusual symptoms. If tissue samples were collected, the results will be communicated to the patient once they are available. Patients should be advised to report any significant pain, bleeding, or difficulty swallowing that may occur following the procedure.

Short Descr ESOPHAGOSCOPY FLEX DX BRUSH
Medium Descr ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC
Long Descr Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P8B - Endoscopy - upper gastrointestinal
MUE 1
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
Action
Notes
2015-01-01 Changed Description Changed
2014-01-01 Added Added
Code
Description
Code
Description
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"