How To Use CPT Code 43198

CPT 43198 describes the procedure of esophagoscopy, which involves the use of a flexible endoscope passed through the nose 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 43198?

CPT 43198 is a code used to describe the procedure of esophagoscopy. This procedure involves the insertion of a flexible endoscope through the nose, down the throat, and into the esophagus to view and examine the upper gastrointestinal tract. During the procedure, the healthcare provider may also perform one or more biopsies to obtain tissue samples for further examination.

2. Official Description

The official description of CPT code 43198 is: ‘Esophagoscopy, flexible, transnasal; with biopsy, single or multiple.’

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. A flexible endoscope is inserted through the patient’s nose and guided down the throat into the esophagus.
3. The healthcare provider inspects the esophagus for any abnormalities or signs of disease.
4. If necessary, the healthcare provider may perform one or more biopsies, which involve removing a portion or the entirety of suspicious tissue for further examination.
5. The procedure is completed, and the endoscope is removed from the patient.

4. Qualifying circumstances

CPT 43198 is used for patients who require esophagoscopy with biopsy. This procedure is typically performed to evaluate and diagnose abnormalities or diseases in the upper gastrointestinal tract. It is important to note that CPT 43198 should not be reported in conjunction with certain other codes, as specified in the notes provided.

5. When to use CPT code 43198

CPT code 43198 should be used when a healthcare provider performs a transnasal esophagoscopy with biopsy on a patient. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the procedure does not involve a biopsy or if a different type of endoscope is used, a different code should be used instead.

6. Documentation requirements

To support a claim for CPT 43198, the healthcare provider must document the following information:

• Reason for performing the esophagoscopy with biopsy
• Details of the procedure, including the use of a flexible endoscope and the transnasal approach
• Documentation of any biopsies performed, including the number and location of the samples taken
• Any abnormalities or findings observed during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43198, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The healthcare provider should also be aware of any restrictions or limitations specified in the notes provided. It is important to accurately report the procedure and any associated biopsies performed. Additionally, it is important to avoid reporting CPT 43198 in conjunction with certain other codes, as specified in the notes.

8. Historical information

CPT 43198 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates or changes to the code since its addition.

9. Examples

1. A gastroenterologist performing a transnasal esophagoscopy with biopsy to evaluate a patient with suspected esophageal cancer.
2. An otolaryngologist using a flexible endoscope to perform a transnasal esophagoscopy with biopsy on a patient with recurrent throat pain.
3. A general surgeon performing a transnasal esophagoscopy with biopsy to investigate the cause of persistent acid reflux in a patient.
4. An oncologist performing a transnasal esophagoscopy with biopsy to monitor the progression of a known esophageal tumor.
5. A gastroenterologist performing a transnasal esophagoscopy with biopsy to evaluate a patient with difficulty swallowing.
6. A pulmonologist using a flexible endoscope to perform a transnasal esophagoscopy with biopsy on a patient with a history of lung cancer and suspected metastasis to the esophagus.
7. An otolaryngologist performing a transnasal esophagoscopy with biopsy to investigate the cause of chronic cough in a patient.
8. A gastroenterologist performing a transnasal esophagoscopy with biopsy to evaluate a patient with unexplained weight loss.
9. An oncologist using a flexible endoscope to perform a transnasal esophagoscopy with biopsy on a patient with a family history of esophageal cancer.
10. A general surgeon performing a transnasal esophagoscopy with biopsy to investigate the cause of recurrent vomiting in a patient.