How To Use CPT Code 43196

CPT 43196 describes the procedure of esophagoscopy, which involves the insertion of a rigid endoscope through the mouth to view the esophagus. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43196?

CPT 43196 is a code used to describe the procedure of esophagoscopy. This procedure involves the insertion of a rigid endoscope through the patient’s mouth and down the throat to examine the esophagus. During the procedure, a guidewire is inserted, followed by the use of one or more dilators to achieve the required amount of dilation. It is important to note that CPT 43196 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 flexible transoral esophagoscopy with insertion of a guidewire followed by dilation, code 43226 should be used.

2. Official Description

The official description of CPT code 43196 is: ‘Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire.’ It is important to note that this code should not be reported with codes 43191, 43197, or 43198, and if fluoroscopic guidance is performed, code 74360 should be used instead. For flexible transoral esophagoscopy with insertion of a guidewire followed by dilation, code 43226 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 and identifies any abnormalities or conditions that require treatment.
4. A guidewire, such as the Savary-Gillard wire, is inserted into the esophagus.
5. The endoscope is then removed, and the provider uses the guidewire as a guide to insert one or more dilators into the esophagus.
6. The dilators are used to widen the lumen of the esophagus to achieve the required amount of dilation.

4. Qualifying circumstances

CPT 43196 is typically performed on patients who require examination and treatment of abnormalities in the upper gastrointestinal tract. The procedure is specifically used for the esophagus, which is the long tubular portion of the digestive tract that stretches between the throat and the stomach. The use of a rigid endoscope allows for a thorough inspection of the esophagus, and the insertion of a guidewire followed by dilation helps to address any narrowing or strictures in the esophagus. It is important to note that CPT 43196 should not be reported with codes 43191, 43197, or 43198.

5. When to use CPT code 43196

CPT code 43196 should be used when a healthcare provider performs a rigid esophagoscopy procedure with the insertion of a guidewire followed by dilation over the guidewire. It is important to note that this code should not be reported with codes 43191, 43197, or 43198. If fluoroscopic guidance is performed during the procedure, code 74360 should be used instead. For flexible transoral esophagoscopy with insertion of a guidewire followed by dilation, code 43226 should be used.

6. Documentation requirements

To support a claim for CPT 43196, the healthcare provider must document the following information:

• Patient’s diagnosis or reason for the esophagoscopy procedure
• Details of the procedure, including the insertion of the guidewire and the use of dilators
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43196, it is important to ensure that the procedure meets the criteria outlined in the official description. This includes the insertion of a guidewire followed by dilation over the guidewire. It is also important to note that CPT 43196 should not be reported with codes 43191, 43197, or 43198. If fluoroscopic guidance is performed during the procedure, code 74360 should be used instead. For flexible transoral esophagoscopy with insertion of a guidewire followed by dilation, code 43226 should be used.

8. Historical information

CPT code 43196 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 a rigid esophagoscopy with the insertion of a guidewire followed by dilation to address a stricture in the patient’s esophagus.
2. A general surgeon performs a rigid esophagoscopy with the insertion of a guidewire followed by dilation to treat a patient with achalasia.
3. An otolaryngologist performs a rigid esophagoscopy with the insertion of a guidewire followed by dilation to address a narrowing in the patient’s esophagus caused by scar tissue.
4. A thoracic surgeon performs a rigid esophagoscopy with the insertion of a guidewire followed by dilation to treat a patient with a benign esophageal stricture.