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Esophagoscopy, specifically the flexible transoral approach, is a medical procedure that involves the use of a flexible endoscope to visualize and treat conditions affecting the esophagus. This procedure is particularly focused on the dilation of the esophagus using a balloon that is 30 mm in diameter or larger. The primary purpose of esophageal dilation is to alleviate strictures, which are areas of narrowing within the esophagus that can impede the passage of food and liquids. Such strictures may arise from various underlying conditions, including reflux esophagitis, which leads to inflammation and scarring of the esophageal lining; Schatzki's ring, a benign fibrous tissue formation located in the distal esophagus; congenital esophageal atresia, a birth defect affecting the esophagus; or malignant diseases that can cause obstruction. During the procedure, the endoscope is introduced through the mouth, allowing for a thorough examination of the velopharyngeal closure, base of the tongue, and hypopharynx. The motion of the vocal cords is assessed, and the pharyngeal musculature is evaluated. As the endoscope is advanced to the cricopharyngeus, the patient may be instructed to burp or swallow to facilitate the passage of the scope. The entire length of the esophagus is then examined, and any abnormalities are documented. Following this, the balloon catheter is carefully advanced to the site of the stricture, where it is inflated to the appropriate pressure to achieve dilation. The balloon remains inflated for a brief period, after which it is deflated and removed. The area of stricture is subsequently inspected to confirm the success of the dilation and to check for any potential injuries resulting from the procedure.
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Esophageal dilation via flexible esophagoscopy is indicated for several specific conditions that lead to narrowing of the esophagus. These indications include:
The procedure of flexible esophagoscopy with dilation involves several critical steps to ensure effective treatment of esophageal strictures. First, the patient is positioned appropriately, and sedation may be administered to ensure comfort during the procedure. The flexible endoscope is then introduced transorally, allowing the physician to visualize the esophagus. As the endoscope is advanced, the velopharyngeal closure, base of the tongue, and hypopharynx are examined for any abnormalities. The motion of the vocal cords is assessed, and the pharyngeal musculature is evaluated to ensure there are no issues that could complicate the procedure. When the endoscope reaches the cricopharyngeus, the patient may be asked to perform a swallowing maneuver or to burp, which aids in the smooth passage of the scope into the esophagus. The endoscope is then carefully advanced through the entire length of the esophagus to the gastroesophageal junction, where any abnormalities are documented. After reaching the area of stricture, the scope is withdrawn slightly to allow for a thorough examination of the esophagus' circumference, particularly focusing on the stricture site. Using fluoroscopic guidance, if necessary, a deflated balloon catheter is then advanced through the instrument channel of the endoscope to the center of the stricture. The balloon is inflated while monitoring the pressure to achieve optimal dilation. This inflation is maintained for a short duration, typically between 30 seconds to 2 minutes, before the balloon is deflated and removed. Following the dilation, the area of stricture is re-evaluated using the endoscope to confirm the success of the procedure and to check for any potential injuries that may have occurred during the dilation process.
After the completion of the esophagoscopy and dilation procedure, patients are typically monitored for a short period to ensure there are no immediate complications. It is common for patients to experience some throat discomfort or mild soreness following the procedure, which usually resolves quickly. Patients may be advised to start with a soft diet and gradually return to their normal diet as tolerated. Follow-up appointments may be scheduled to assess the effectiveness of the dilation and to monitor for any recurrence of strictures. Additionally, any specific post-procedure instructions regarding activity restrictions or medication adjustments will be provided by the healthcare provider to ensure optimal recovery.
| Short Descr | ESOPHAGOSC DILATE BALLOON 30 | Medium Descr | ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM | Long Descr | Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) | 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 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | 1 |
| 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Added | Added |
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