How To Use CPT Code 43192

CPT 43192 describes the procedure of esophagoscopy with directed submucosal injection(s) using a rigid endoscope. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43192?

CPT 43192 is used to describe the procedure of esophagoscopy with directed submucosal injection(s) using a rigid endoscope. This code is specifically used when the provider inserts a rigid endoscope through the patient’s mouth and down into the esophagus to perform one or more injections into the submucosa, which is the tissue below the mucous membrane.

2. Official Description

The official description of CPT code 43192 is: ‘Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance.’

3. Procedure

1. The provider prepares the patient and administers anesthesia as necessary.
2. Using a rigid endoscope, the provider inserts the instrument through the patient’s mouth and maneuvers it into the esophagus.
3. The provider inspects the area using the endoscope to identify any abnormalities or lesions.
4. If necessary, the provider performs one or more submucosal injections into the tissue below the mucous membrane using a needle-tipped catheter inserted through the scope.
5. The injections may involve various substances, such as botulinum toxin, steroids, India ink, or saline, depending on the purpose of the procedure.
6. After completing the injections, the provider removes all instruments from the patient.

4. Qualifying circumstances

CPT 43192 is typically performed on patients who require examination and treatment of abnormalities in the upper gastrointestinal tract, specifically the esophagus. The procedure involves the use of a rigid endoscope and directed submucosal injections. It should not be reported in conjunction with other esophagoscopy codes, such as 43191, 43197, or 43198. For flexible transoral esophagoscopy with directed submucosal injection(s), use code 43201. Injection sclerosis of esophageal varices should be reported with code 43204 for flexible transoral esophagoscopy or code 43499 for rigid transoral esophagoscopy.

5. When to use CPT code 43192

CPT code 43192 should be used when a provider performs esophagoscopy with directed submucosal injection(s) using a rigid endoscope. It is important to note that this code should not be used for injection sclerosis of esophageal varices or when a flexible endoscope is used.

6. Documentation requirements

To support a claim for CPT 43192, the provider must document the following information:

• Reason for the procedure and the need for directed submucosal injections
• Details of the injections performed, including the substances used
• Date and duration of the procedure
• Any abnormalities or lesions identified during the examination
• Any additional procedures or treatments performed during the same session
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43192, ensure that the procedure involves the use of a rigid endoscope and directed submucosal injections. Do not report this code in conjunction with other esophagoscopy codes. It is important to check payer and coding guidelines for any specific requirements or restrictions.

8. Historical information

CPT 43192 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A gastroenterologist performs esophagoscopy with directed submucosal injection of botulinum toxin to treat a patient with achalasia.
2. An otolaryngologist uses a rigid endoscope to perform esophagoscopy with directed submucosal injection of India ink to mark a suspicious lesion for surgical removal.
3. A surgeon performs esophagoscopy with directed submucosal injection of saline to lift a polyp for easier removal.
4. A gastroenterologist performs esophagoscopy with directed submucosal injection of steroids to treat a patient with eosinophilic esophagitis.
5. An interventional radiologist uses a rigid endoscope to perform esophagoscopy with directed submucosal injection of a sclerosing agent to treat esophageal varices.
6. A gastroenterologist performs esophagoscopy with directed submucosal injection of saline to dilate a narrowed esophagus in a patient with strictures.
7. An otolaryngologist uses a rigid endoscope to perform esophagoscopy with directed submucosal injection of steroids to treat a patient with vocal cord granuloma.
8. A surgeon performs esophagoscopy with directed submucosal injection of botulinum toxin to treat a patient with spasmodic dysphonia.
9. An interventional radiologist uses a rigid endoscope to perform esophagoscopy with directed submucosal injection of India ink to mark the margins of a tumor for surgical resection.
10. A gastroenterologist performs esophagoscopy with directed submucosal injection of saline to treat a patient with esophageal diverticulum.