© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 43257 involves a specialized endoscopic technique known as esophagogastroduodenoscopy (EGD), which is performed using a flexible, transoral approach. This procedure is primarily indicated for the treatment of gastroesophageal reflux disease (GERD), a condition where stomach acid frequently flows back into the esophagus, causing symptoms such as heartburn and regurgitation. During the procedure, the patient’s mouth and throat are first numbed with an anesthetic spray to minimize discomfort. A hollow mouthpiece is then placed in the mouth to facilitate the insertion of the flexible fiberoptic endoscope. As the patient swallows, the endoscope is carefully advanced through the esophagus, allowing for direct visualization of the esophageal lining and any potential abnormalities. Once the endoscope reaches the stomach, it is inflated with air to enhance visibility, and various regions of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, are thoroughly inspected. The procedure may extend into the duodenum or jejunum, where the mucosal surfaces are also examined. A guidewire is then introduced through the endoscope to assist in the placement of a thermal catheter, which is used to deliver thermal energy to the lower esophageal sphincter and/or gastric cardia. This thermal energy is intended to create lesions that can help alleviate the symptoms of GERD by modifying the function of the esophageal sphincter. The careful monitoring and inspection throughout the procedure ensure that the thermal lesions are accurately placed, contributing to the overall effectiveness of the treatment.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 43257 is indicated for the treatment of gastroesophageal reflux disease (GERD). This condition is characterized by the backward flow of stomach contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and discomfort. The procedure aims to address the underlying dysfunction of the lower esophageal sphincter and/or gastric cardia, which may contribute to the severity of GERD symptoms.
The procedure begins with the administration of an anesthetic spray to numb the patient's mouth and throat, ensuring comfort during the endoscopic examination. A hollow mouthpiece is then inserted into the mouth to facilitate the passage of the flexible fiberoptic endoscope. As the patient swallows, the endoscope is carefully advanced through the esophagus, guided by direct visualization. Once the endoscope passes beyond the cricopharyngeal region, the esophagus is thoroughly inspected for any abnormalities, such as inflammation or lesions.
Post-procedure care following the esophagogastroduodenoscopy with thermal energy delivery involves monitoring the patient for any immediate complications, such as bleeding or perforation. Patients may experience some discomfort or a sore throat due to the procedure, which typically resolves within a few days. It is essential for patients to follow any specific post-procedure instructions provided by their healthcare provider, which may include dietary modifications and activity restrictions. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to monitor for any recurrence of GERD symptoms.
| Short Descr | EGD W/THRML TXMNT GERD | Medium Descr | EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD | Long Descr | Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease | 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 | 43235 Esophagogastroduodenoscopy, 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) | P6C - Minor procedures - other (Medicare fee schedule) | 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. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Changed | Description Changed |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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