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Esophagoscopy, flexible, transoral, with endoscopic ultrasound examination, is a diagnostic procedure that involves the use of a flexible endoscope to visualize the esophagus. The procedure begins with the introduction of the endoscope through the mouth, allowing for direct access to the esophagus. During this 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 through this area. The endoscope is then carefully advanced along the entire length of the esophagus until it reaches the gastroesophageal junction, where any abnormalities encountered are meticulously noted. After the initial endoscopic examination, an echoendoscope is introduced to further investigate any identified lesions or abnormalities. This advanced imaging technique utilizes ultrasound to capture detailed images, allowing for the differentiation between intrinsic lesions, which are located within the esophagus, and extrinsic lesions, which originate from outside the esophagus. The evaluation of intrinsic lesions includes determining their extent, whether they are confined to the mucosa or have penetrated into the muscular wall. For extrinsic lesions, the assessment focuses on their relationship to surrounding structures, including the mediastinal space, thoracic organs, and any potential lymph node involvement. The procedure concludes with the production of hard copies of the ultrasound images for further evaluation of the identified abnormalities.
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Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination is indicated for a variety of clinical scenarios where detailed visualization and assessment of the esophagus and surrounding structures are necessary. The following conditions may warrant this procedure:
The procedure of esophagoscopy with endoscopic ultrasound examination involves several critical steps to ensure thorough evaluation and accurate diagnosis. The following procedural steps are performed:
After the completion of the esophagoscopy with endoscopic ultrasound examination, the patient is monitored for any immediate post-procedural complications. It is common for patients to experience a sore throat or mild discomfort, which typically resolves within a few hours. Patients may be advised to refrain from eating or drinking until the effects of sedation have worn off and swallowing is comfortable. Follow-up appointments may be scheduled to discuss the findings of the procedure, review any biopsy results, and determine the need for further diagnostic or therapeutic interventions based on the outcomes of the examination.
| Short Descr | ESOPHAGOSCOP ULTRASOUND EXAM | Medium Descr | ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM | Long Descr | Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 |
| 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). | 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. | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | 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 |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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