CPT® Code 74235

Official Description

Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation

Common Language Description

The procedure described by CPT® Code 74235 involves the removal of foreign body(ies) from the esophagus utilizing a balloon catheter, with the added component of radiological supervision and interpretation. This method serves as a non-sedated alternative to traditional endoscopy for extracting non-organic, smooth, and radiopaque objects lodged in the esophagus. The use of fluoroscopy is critical in this procedure, as it allows for the precise confirmation of the foreign body(ies) location, shape, and size prior to intervention. The procedure is designed to be performed with the patient in an upright position, ensuring optimal access and visibility during the removal process. The balloon catheter, specifically a Foley catheter, is selected based on the size of the foreign body and is tested for symmetrical inflation to ensure effective operation. The catheter is then inserted either trans-orally or trans-nasally, and the patient is instructed to swallow it. Under continuous fluoroscopic guidance, the catheter is advanced until it is positioned distal to the foreign body(ies). Once in place, the balloon is inflated to expand the esophageal lumen, facilitating the movement of the foreign object. The patient is then repositioned to a prone or oblique position, and gentle traction is applied to the catheter, utilizing gravity to assist in the expulsion of the foreign body(ies) from the esophagus. Following the successful removal, the balloon is deflated, and the catheter is carefully withdrawn. This code not only encompasses the procedural aspects but also includes the radiological supervision, the review and interpretation of the imaging obtained during the procedure, and the documentation of findings in a written report.

1. Indications

The procedure associated with CPT® Code 74235 is indicated for the removal of foreign body(ies) from the esophagus. The specific indications for performing this procedure include:

Foreign Body Presence The presence of non-organic, smooth, and radiopaque objects lodged in the esophagus that require removal.
Patient Condition Patients who may not be suitable for sedation or endoscopic procedures due to various medical conditions or preferences.

2. Procedure

The procedure for the removal of foreign body(ies) from the esophagus using a balloon catheter involves several critical steps:

Step 1: Confirmation of Foreign Body Prior to the procedure, fluoroscopy is utilized to confirm the location, shape, and size of the foreign body(ies) within the esophagus. This imaging technique ensures that the medical team has accurate information to guide the removal process.
Step 2: Catheter Selection and Preparation An appropriate size Foley catheter is selected based on the characteristics of the foreign body. The balloon of the catheter is tested to ensure it inflates symmetrically, which is essential for effective removal.
Step 3: Catheter Insertion With the patient in an upright position, the catheter is inserted either trans-orally or trans-nasally. The patient is instructed to swallow the catheter, facilitating its passage into the esophagus.
Step 4: Advancement Under Fluoroscopy The catheter is advanced under continuous fluoroscopic guidance until it is positioned distal to the foreign body(ies). This step is crucial for ensuring that the catheter is correctly placed for effective removal.
Step 5: Balloon Inflation Once the catheter is in the correct position, the balloon is inflated to expand the lumen of the esophagus. This inflation helps to create space for the foreign body(ies) to be maneuvered out of the esophagus.
Step 6: Patient Positioning and Object Removal The patient is then repositioned to a prone or oblique position. Gentle traction is applied to the catheter while utilizing gravity to assist in moving the foreign body(ies) upward through the esophagus and expelling it out of the mouth.
Step 7: Catheter Removal After the foreign body(ies) has been successfully expelled, the balloon is deflated, and the catheter is carefully removed from the esophagus.

3. Post-Procedure

Post-procedure care following the removal of foreign body(ies) using CPT® Code 74235 typically involves monitoring the patient for any immediate complications or discomfort. Patients may be observed for signs of esophageal injury or other adverse effects resulting from the procedure. It is important to ensure that the patient is stable and that there are no residual foreign body fragments. Documentation of the procedure, including the findings from the radiological supervision and interpretation, is completed in a written report. Further follow-up may be necessary depending on the patient's condition and any underlying issues that may have contributed to the foreign body ingestion.

Short Descr	REMOVE ESOPHAGUS OBSTRUCTION
Medium Descr	RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I
Long Descr	Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No payment adjustment rules for multiple 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)	0 - 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.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I1F - Standard imaging - other
MUE	1
CCS Clinical Classification	211 - Therapeutic radiology

Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.