© Copyright 2025 American Medical Association. All rights reserved.
Esophagoscopy, flexible, transoral, is a medical procedure that involves the use of a flexible endoscope to visualize the esophagus. This procedure is performed by introducing the endoscope through the mouth and advancing it into the distal esophagus. During the 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 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 process are meticulously noted for further evaluation. In conjunction with the esophagoscopy, transendoscopic ultrasound (EUS) is utilized to provide detailed imaging of the thoracic region. A radial scanning echoendoscope is introduced under direct visualization to assess the mediastinum and surrounding structures for enlarged lymph nodes and other lesions. This imaging helps determine the origin of any identified tumors, whether they are arising from the esophagus or other nearby structures, and whether there is any invasion into vital structures. Additionally, the lungs are evaluated for pleural effusion and other potential abnormalities. The ultrasound images captured during the procedure are printed for further analysis. Following the imaging, a linear scanning echoendoscope is used to perform fine needle aspiration or biopsy of any lymph nodes or lesions that are accessible through the esophagus. A needle biopsy catheter is advanced through the echoendoscope's biopsy channel, and Doppler imaging is employed to ensure that no vascular structures obstruct the biopsy path. The needle is then carefully advanced through the esophageal wall into the targeted lesion or lymph node to obtain an aspiration biopsy, which is subsequently sent for cytologic evaluation. Multiple passes may be made at each biopsy site to ensure an adequate specimen is collected, with the biopsy device being cleaned and reassembled after each pass before proceeding to the next site.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of esophagoscopy with transendoscopic ultrasound-guided fine needle aspiration/biopsy is indicated for various clinical scenarios, including but not limited to:
The procedure begins with the patient being positioned appropriately to facilitate access to the esophagus. The flexible endoscope is then introduced transorally, allowing the physician to visualize the distal esophagus. The examination includes assessing the velopharyngeal closure, the base of the tongue, and the hypopharynx. Vocal cord motion is observed, and the pharyngeal musculature is evaluated for any abnormalities. As the endoscope reaches the cricopharyngeus, the patient may be instructed to burp or swallow, which aids in the advancement of the scope through the esophagus to the gastroesophageal junction. Any noted abnormalities during this phase are documented for further analysis.
Once the esophagus is fully examined, a radial scanning echoendoscope is introduced under direct visualization. This echoendoscope utilizes ultrasound imaging to evaluate the thoracic region, specifically assessing the mediastinum and adjacent structures for enlarged lymph nodes and other lesions. The physician determines whether these lesions arise from the esophagus or other structures and evaluates if any tumors have invaded vital surrounding structures. The lungs are also assessed for pleural effusion and other abnormalities. The ultrasound images obtained are printed for further evaluation.
Following the imaging assessment, the radial scanning echoendoscope is removed and replaced with a linear scanning echoendoscope. A needle biopsy catheter is then advanced through the biopsy channel of the echoendoscope. Doppler imaging is performed to ensure that there are no vascular structures obstructing the planned biopsy route. The needle is carefully advanced through the esophageal wall into the identified lesion or lymph node, and an aspiration biopsy is obtained. This specimen is sent for separate cytologic evaluation. Multiple passes may be made at each biopsy site to ensure adequate tissue sampling, with the biopsy device being removed, cleaned, and reassembled after each pass before proceeding to the next site.
After the completion of the esophagoscopy and biopsy procedure, the patient is monitored for any immediate complications, such as bleeding or perforation. Post-procedure care may include instructions regarding diet, activity level, and signs of complications to watch for, such as difficulty swallowing, chest pain, or fever. The patient may be advised to avoid certain activities for a specified period to allow for proper healing. Follow-up appointments are typically scheduled to discuss biopsy results and any further management based on the findings.
| Short Descr | ESOPHAGOSCOPY W/US NEEDLE BX | Medium Descr | ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX | Long Descr | Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) | 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). | 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. | 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. | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | FS | Split (or shared) evaluation and management visit | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 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. |
Get instant expert-level medical coding assistance.