How To Use CPT Code 43249

CPT 43249 refers to an esophagogastroduodenoscopy procedure with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 43249.

1. What is CPT 43249?

CPT 43249 is a medical procedure code used to describe an esophagogastroduodenoscopy (EGD) with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter. This procedure is performed to widen a narrowed area of the esophagus using a flexible endoscope and a balloon dilator.

2. 43249 CPT code description

The official description of CPT code 43249 is: “Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)”.

3. Procedure

The 43249 procedure involves the following steps:

1. Administration of anesthesia to the patient.
2. Insertion of a flexible endoscope through the patient’s mouth.
3. Passing the endoscope down the esophagus, through the stomach, and into the duodenum.
4. Inspection of the esophagus, stomach, and duodenum.
5. Insertion of a balloon dilator through the endoscope to the level of the esophageal stricture.
6. Inflation of the balloon to widen the narrowed area of the esophagus (less than 30 mm in diameter).
7. Deflation and removal of the balloon dilator.
8. Reinspection of the esophagus and removal of the endoscope.

4. Qualifying circumstances

Patients eligible to receive CPT code 43249 services are those who have a narrowed area in their esophagus, which may be caused by conditions such as esophageal strictures, achalasia, or eosinophilic esophagitis. The procedure is performed to alleviate symptoms such as difficulty swallowing, regurgitation, and chest pain. A healthcare provider will determine if a patient is a suitable candidate for this procedure based on their medical history, symptoms, and diagnostic tests.

5. When to use CPT code 43249

It is appropriate to bill the 43249 CPT code when a provider performs an EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter. This code should be used when the procedure is medically necessary to treat a patient’s esophageal narrowing and when other treatment options have been unsuccessful or are not suitable for the patient.

6. Documentation requirements

To support a claim for CPT 43249, the following information should be documented:

• Patient’s medical history and symptoms related to esophageal narrowing.
• Diagnostic tests performed to confirm the presence of esophageal narrowing.
• Indication that other treatment options have been unsuccessful or are not suitable for the patient.
• Detailed description of the procedure, including the size of the balloon dilator used and the extent of dilation achieved.
• Post-procedure findings and any complications encountered during the procedure.
• Follow-up care plan and recommendations for the patient.

7. Billing guidelines

When billing for CPT code 43249, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 43249 include:

• Do not report CPT 43249 in conjunction with codes 43197, 43198, 43235, 43266, 43270, 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373, 44376, 44377, 44378, and 44379.
• If fluoroscopic guidance is performed, use code 74360.
• Ensure that the documentation supports the medical necessity of the procedure and includes all required information.
• Verify the patient’s insurance coverage and obtain any necessary pre-authorizations before performing the procedure.

8. Historical information

CPT 43249 was added to the Current Procedural Terminology system on January 1, 1995. The code was changed on January 1, 2014, with the previous descriptor being “Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less than 30 mm diameter)”.

9. Similar codes to CPT 43249

Five similar codes to CPT 43249 and how they differentiate from CPT 43249 are:

1. CPT 43233: This code is used for EGD with balloon dilation of the esophagus to a diameter of 30 mm or greater.
2. CPT 43220: This code is used for a flexible transoral esophagoscopy with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter.
3. CPT 43214: This code is used for a flexible esophagoscopy with balloon dilation of the esophagus to a diameter of 30 mm or greater.
4. CPT 43195: This code is used for a rigid esophagoscopy with balloon dilation of the esophagus to a diameter of less than 30 mm.
5. CPT 43197: This code is used for a rigid transoral esophagoscopy with balloon dilation of the esophagus less than 30 mm in diameter.

10. Examples

Here are 10 detailed examples of CPT code 43249 procedures:

1. A 55-year-old patient with a history of gastroesophageal reflux disease (GERD) presents with difficulty swallowing. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to treat an esophageal stricture.
2. A 45-year-old patient with achalasia undergoes an EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter to alleviate symptoms of dysphagia and regurgitation.
3. A 60-year-old patient with eosinophilic esophagitis presents with chest pain and difficulty swallowing. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to widen the narrowed esophagus.
4. A 50-year-old patient with a history of radiation therapy for esophageal cancer undergoes an EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter to treat a radiation-induced stricture.
5. A 40-year-old patient with a history of caustic ingestion presents with dysphagia. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to treat a caustic-induced stricture.
6. A 65-year-old patient with a history of esophageal surgery presents with recurrent dysphagia. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to treat a post-surgical stricture.
7. A 35-year-old patient with a history of chronic esophagitis presents with difficulty swallowing. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to treat an esophageal stricture caused by inflammation.
8. A 70-year-old patient with a history of esophageal stenting presents with recurrent dysphagia. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to treat a stricture at the site of the stent.
9. A 30-year-old patient with a history of esophageal diverticulum presents with difficulty swallowing. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to treat a stricture at the site of the diverticulum.
10. A 75-year-old patient with a history of esophageal varices presents with difficulty swallowing. An EGD with transendoscopic balloon dilation of the esophagus less than 30 mm in diameter is performed to treat a stricture caused by the varices.