How To Use CPT Code 43195

CPT 43195 describes a specific procedure known as esophagoscopy with balloon dilation. This article will provide an overview of CPT code 43195, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43195?

CPT 43195 is a code used to describe the procedure of esophagoscopy with balloon dilation. This procedure involves the insertion of a rigid endoscope through the mouth and into the esophagus. Once the endoscope is in place, a balloon is inserted through the scope and inflated to widen a narrowed area in the esophagus. It is important to note that CPT 43195 should not be reported in conjunction with codes 43191, 43197, or 43198. If fluoroscopic guidance is performed during the procedure, code 74360 should be used. For esophageal dilation with a balloon 30 mm diameter or larger, codes 43214 and 43233 should be used. For dilation without endoscopic visualization, codes 43450 and 43453 are appropriate. Additionally, for flexible transoral esophagoscopy with balloon dilation of less than 30 mm diameter, code 43220 should be used.

2. Official Description

The official description of CPT code 43195 is: ‘Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter).’ It is important to note that this code should not be reported in conjunction with codes 43191, 43197, or 43198. If fluoroscopic guidance is performed, code 74360 should be used. For esophageal dilation with a balloon 30 mm diameter or larger, codes 43214 and 43233 should be used. For dilation without endoscopic visualization, codes 43450 and 43453 are appropriate. For flexible transoral esophagoscopy with balloon dilation of less than 30 mm diameter, code 43220 should be used.

3. Procedure

1. The procedure begins with the administration of anesthesia to the patient.
2. The healthcare provider inserts a rigid endoscope through the patient’s mouth, down the throat, and into the esophagus.
3. The provider inspects the esophagus for any abnormalities or strictures (narrowed areas).
4. If a stricture is present, the provider inserts a balloon through the strictured area.
5. The balloon is then inflated to increase the diameter of the esophagus and dilate the stricture.
6. Once the desired dilation is achieved, the provider removes the balloon dilator and the endoscope.