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The procedure described by CPT® Code 43201 refers to a flexible esophagoscopy performed transorally, which involves the use of a flexible endoscope to visualize the esophagus. This diagnostic procedure allows for a thorough examination of the esophagus, including the velopharyngeal closure, base of the tongue, and hypopharynx. During the esophagoscopy, the physician observes vocal cord motion and evaluates the pharyngeal musculature. The endoscope is introduced through the mouth and carefully advanced into the esophagus, reaching the gastroesophageal junction. Any abnormalities encountered during the procedure are meticulously noted. In addition to visual examination, the procedure may involve the collection of tissue specimens through brushing or washing techniques. In the context of CPT® Code 43201, the procedure is further enhanced by the inclusion of directed submucosal injection(s) of any substance. This step is crucial for various therapeutic and diagnostic purposes. Common substances used for injection include India ink, which is utilized for tattooing lesions to aid in their identification prior to excision, as well as saline, epinephrine, and corticosteroids. Saline or epinephrine injections serve to separate the mucosal layer from the muscle layer of the esophagus, facilitating the elevation of lesions for excision. Additionally, botulinum toxin is specifically indicated for the treatment of esophageal achalasia, where it is injected into the esophageal sphincter. The procedure may involve one or more submucosal injections, which are performed prior to any separately reportable lesion excision, thereby enhancing the overall effectiveness of the esophagoscopy.
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The procedure described by CPT® Code 43201 is indicated for various conditions that necessitate a detailed examination and potential treatment of the esophagus. The following are explicitly provided indications for performing this procedure:
The procedure for CPT® Code 43201 involves several critical steps that ensure a comprehensive evaluation and treatment of the esophagus. The following procedural steps are outlined:
Post-procedure care following CPT® Code 43201 involves monitoring the patient for any immediate complications that may arise from the esophagoscopy and submucosal injections. Patients may experience mild discomfort or a sore throat following the procedure, which typically resolves quickly. It is essential to provide instructions regarding dietary modifications, such as avoiding solid foods for a short period, and to monitor for any signs of complications, such as bleeding or difficulty swallowing. Follow-up appointments may be necessary to discuss the findings and any further treatment options based on the results of the esophagoscopy.
| Short Descr | ESOPH SCOPE W/SUBMUCOUS INJ | Medium Descr | ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ | Long Descr | Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic 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. | Endoscopic Base Code | 43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | 1 | CCS Clinical Classification | 70 - Upper gastrointestinal endoscopy, biopsy |
| 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. | 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). | 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 | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Changed | Description Changed |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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