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Esophagoscopy is a medical procedure that involves the use of a flexible endoscope to visually examine the esophagus, which is the tube that connects the throat to the stomach. This procedure is performed transorally, meaning the endoscope is inserted through the mouth. During the esophagoscopy, the physician evaluates various anatomical structures, including the velopharyngeal closure, the base of the tongue, and the hypopharynx. The examination also includes observing vocal cord motion and assessing the pharyngeal musculature. The endoscope is advanced through the esophagus to the gastroesophageal junction, allowing for a thorough inspection of the esophageal lining for any abnormalities such as tumors, polyps, or other lesions. In cases where lesions are identified, the procedure includes the ablation of these growths. Ablation refers to the removal or destruction of tissue, which in this context is achieved using a laser device. Prior to the ablation, if necessary, the esophagus may be dilated to facilitate the procedure. This dilation can be accomplished through the insertion of a guidewire and the use of rigid tubes or a balloon catheter. The ablation process involves carefully targeting the lesions with the laser as the endoscope is retracted, ensuring complete destruction of the abnormal tissue. Following the ablation, the esophagus is re-examined to confirm that all lesions have been effectively treated and to check for any potential injuries resulting from the procedure. This comprehensive approach ensures that the esophagus is thoroughly evaluated and treated as needed.
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Esophagoscopy with ablation is indicated for the following conditions:
The esophagoscopy procedure begins with the introduction of a flexible endoscope through the patient's mouth. The physician carefully navigates the endoscope through the oropharynx, examining the velopharyngeal closure, base of the tongue, and hypopharynx. Vocal cord motion is assessed, and the pharyngeal musculature is evaluated for any abnormalities. As the endoscope reaches the cricopharyngeus, the patient may be instructed to burp or swallow to facilitate the passage of the scope. The endoscope is then advanced along the entire length of the esophagus until it reaches the gastroesophageal junction, where any abnormalities are documented. Once the examination is complete, the endoscope is withdrawn to allow for a thorough inspection of the esophageal lining, specifically noting the locations of any lesions that require ablation. If dilation of the esophagus is necessary prior to the ablation, a guidewire is inserted through the endoscope. Rigid tubes of increasing diameter are then passed over the guidewire to dilate the esophageal lumen as needed. Alternatively, a balloon catheter may be advanced to the site of any strictures and inflated to achieve dilation. Following dilation, a laser device is introduced through the endoscope and positioned at the distal margin of the most distal lesion. The ablation process begins as the endoscope is retracted, with the laser destroying the lesion in a distal to proximal direction. This process is repeated for each lesion until all targeted tissue has been effectively ablated. If further dilation is required after the lesions have been destroyed, the same dilation techniques are employed as previously described. Finally, the esophagus is re-examined using the endoscope to ensure that all lesions have been adequately treated and to check for any injuries resulting from the procedure.
After the esophagoscopy with ablation, patients are typically monitored for any immediate complications. It is essential to assess for signs of bleeding, perforation, or infection. Patients may experience some discomfort or a sore throat following the procedure, which is generally temporary. Instructions regarding diet and activity levels may be provided, and follow-up appointments are often scheduled to evaluate the healing process and to ensure that all lesions have been successfully treated. Additionally, any biopsy results or further treatment plans will be discussed during these follow-up visits.
| Short Descr | ESOPHAGOSCOPY LESION ABLATE | Medium Descr | ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION | Long Descr | Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, 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 | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 96570 | Addon Code MPFS Status: Active Code APC N PUB 100 CPT Assistant Article Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); first 30 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract) | 96571 | Addon Code MPFS Status: Active Code APC N PUB 100 CPT Assistant Article Photodynamic therapy by endoscopic application of light to ablate abnormal tissue via activation of photosensitive drug(s); each additional 15 minutes (List separately in addition to code for endoscopy or bronchoscopy procedures of lung and gastrointestinal tract) |
| 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). | 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). | 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. | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | 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 | Added | Added |
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