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CPT®
43228

CPT® Code 43228
Deleted

Code deleted, see 43229

Official Description

Esophagoscopy, rigid or flexible; with ablation of tumor(s), polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Esophagoscopy, as described by CPT® Code 43228, involves the use of either a rigid or flexible endoscope to visualize the esophagus. This procedure is specifically performed for the ablation of tumors, polyps, or other lesions that cannot be removed using standard techniques such as hot biopsy forceps, bipolar cautery, or snare technique. The endoscope is introduced through the patient's mouth or nose and carefully advanced into the esophagus, allowing for a thorough examination of the velopharyngeal closure, the base of the tongue, and the hypopharynx. During this process, the motion of the vocal cords is observed, and the pharyngeal musculature is evaluated to ensure proper function. As the endoscope reaches the cricopharyngeus, the patient may be instructed to burp or swallow, which aids in the smooth passage of the scope through the esophagus to the gastroesophageal junction. Any abnormalities encountered during this examination are meticulously noted. Following the identification of the tumor, polyp, or lesion, ablation is performed using a technique such as laser ablation. The laser device is introduced through the endoscope and positioned at the distal margin of the lesion. Ablation begins at this distal margin and continues as the endoscope is retracted, ensuring that the entire lesion is effectively destroyed.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

Esophagoscopy with ablation is indicated for the following conditions:

  • Presence of Tumors The procedure is performed when tumors are identified in the esophagus that require ablation rather than removal.
  • Polyps Polyps that are not amenable to removal by standard techniques may necessitate this procedure for effective treatment.
  • Other Lesions Any other lesions in the esophagus that cannot be removed using hot biopsy forceps, bipolar cautery, or snare technique are also indications for this procedure.

2. Procedure

The procedure involves several critical steps to ensure effective ablation of the identified lesions:

  • Step 1: Introduction of the Endoscope The procedure begins with the careful introduction of a rigid or flexible endoscope through the patient's mouth or nose. This step is crucial for gaining access to the esophagus.
  • Step 2: Advancement through the Esophagus Once introduced, the endoscope is advanced through the esophagus. During this phase, the velopharyngeal closure, base of the tongue, and hypopharynx are examined to assess any abnormalities.
  • Step 3: Evaluation of Vocal Cords and Pharyngeal Musculature The motion of the vocal cords is observed, and the pharyngeal musculature is evaluated to ensure proper function, which is essential for swallowing and airway protection.
  • Step 4: Passage through the Cricopharyngeus As the endoscope reaches the cricopharyngeus, the patient may be asked to burp or swallow. This maneuver facilitates the passage of the endoscope into the esophagus.
  • Step 5: Examination of the Esophagus The endoscope is advanced to the gastroesophageal junction, where any abnormalities are noted. This thorough examination is critical for identifying lesions that require treatment.
  • Step 6: Identification and Ablation of Lesions After identifying the tumor, polyp, or lesion, the ablation process begins. A laser device is delivered through the endoscope to the distal margin of the lesion, and ablation is performed by retracting the endoscope while applying the laser, ensuring complete destruction of the lesion.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications following the esophagoscopy and ablation. Patients may experience some discomfort or throat irritation, which is typically managed with supportive care. It is essential to provide instructions regarding dietary modifications and activity restrictions as the esophagus heals. Follow-up appointments may be necessary to assess the effectiveness of the ablation and to monitor for any recurrence of lesions.
Short Descr ESOPH ENDOSCOPY ABLATION
Medium Descr ESPHGSC RGD/FLX ABLTJ TUM XCP HOT BX/CAUT/SNARE
Long Descr Esophagoscopy, rigid or flexible; with ablation of tumor(s), polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
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 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 Procedure or Service, Multiple Reduction Applies
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE Not applicable/unspecified.
CCS Clinical Classification 70 - Upper gastrointestinal endoscopy, biopsy
Date
Action
Notes
2014-01-01 Deleted Code deleted, see 43229
2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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